Serum periostin and carcinoembryonic antigen for diagnosing and assessing response in allergic bronchopulmonary aspergillosis

Background and Objective: Serum periostin and carcinoembryonic antigen (CEA) are markers of type 2 inflammation. However, their role in diagnosing and monitoring treatment responses in allergic bronchopulmonary aspergillosis (ABPA) remains uncertain. The objective of the study was to assess the diagnostic performance of serum CEA and periostin in distinguishing ABPA from asthma. We also evaluate their usefulness in monitoring treatment responses. Methods: We enrolled consecutive subjects with ABPA (cases) and asthmatic patients without ABPA (controls). Serum periostin and CEA levels were measured at baseline and again 2 months after oral prednisolone. We constructed receiver operating characteristic (ROC) curves and determined sensitivity and specificity using the optimal cut-off derived from Youden’s index. Results: We enrolled 112 and 108 subjects with ABPA and asthma (median age: 34 years) respectively. At baseline, the median serum periostin (22.03 vs 16.36 ng/mL; P < 0.001) and CEA levels (4.80 vs 2.35 ng/mL; P < 0.001) were significantly higher in the ABPA group than in the controls. CEA (AUROC = 0.77) showed better diagnostic accuracy than serum periostin (AUROC = 0.64) in differentiating asthma from ABPA. After 2 months of treatment, median serum CEA (4.8 ng/mL vs 3.7 ng/mL) and periostin levels (22.03 vs 17.74 ng/mL) declined significantly. However, 34% and 30% of subjects exhibited increased periostin and CEA levels following treatment. Conclusion: While serum CEA and periostin exhibit modest diagnostic performance in differentiating ABPA from asthma, they are suboptimal for monitoring treatment responses. Further studies are required to validate our findings.