Carcinoembryonic antigen predicts waitlist mortality in lung transplant candidates with idiopathic pulmonary fibrosis

Abstract

OBJECTIVES: Elevated serum carcinoembryonic antigen (CEA) has been reported in lung transplant candidates with idiopathic pulmonary fibrosis, but its association with waitlist mortality is not known. In this study, we evaluated the ability of the serum CEA level to predict waitlist mortality in these patients. METHODS: Fifty-nine patients with idiopathic pulmonary fibrosis who were enrolled as lung transplant candidates between January 2004 and December 2014 were retrospectively reviewed. Serum CEA was measured as part of routine evaluation. RESULTS: Thirty-seven of the 59 patients underwent lung transplantation with a median waiting time of 91 days. Twenty-two patients died while on the waitlist. In univariable analysis, 6-min walking distance, lung allocation score and serum CEA level were identified as being significant prognostic factors. We constructed 2 multivariable models using forced vital capacity, CEA and 6-min walking distance (Model 1, concordance index 0.758) and CEA and lung allocation score (Model 2, concordance index 0.689). CEA was independently associated with waitlist mortality in Model 1 [hazard ratio 1.074, 95% confidence interval (CI)_ 1.004-1.137] and in Model 2 (hazard ratio 1.065, 95% CI 1.008-1.126). The cut-off values that best discriminated 30-day mortality and 6-month mortality by receiver-operating characteristic curve analysis were 8.55 ng/ml and 4.50 ng/ml, respectively. CONCLUSIONS: There was a significant association between elevated serum CEA and increased risk of mortality in waitlisted transplant candidates with idiopathic pulmonary fibrosis.