Abstract

ZHANG, Ji; LI, Wenhua; HUI, Jie  and  XIAO, Jianqiang. Elevated CA125 values predict adverse outcomes in acute heart failure. Invest. clín [online]. 2024, vol.65, n.3, pp.308-320.  Epub Sep 12, 2024. ISSN 0535-5133.  https://doi.org/10.54817/ic.v65n3a04.

In acute heart failure (AHF), elevated carbohydrate antigen 125 (CA125) and N-terminal pro-B-type natriuretic peptide (NTproBNP) have been shown to correlate with adverse events. We sought to quantify their prognostic usefulness in predicting the six-month combined death/heart failure readmission endpoint. The study included 352 patients admitted for AHF. The primary endpoint was the six-month combined endpoint of death/AHF rehospitalization. CA125 and NTproBNP were dichotomized according to the best cut-offs to predict the six-month primary endpoint. The independent association of CA125 and NTproBNP with the primary endpoint was assessed by multivariate Cox regression analysis, and their incremental prognostic utility was evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index. Forty-seven (13.4%) deaths and 113 (32.1%) AHF rehospitalizations were identified at the six-month follow-up. The subjects with CA125≥39.7 U/mL and NTproBNP≥3900 pg/mL had significantly higher cumulative event rates (56.1% vs. 33.3% and 53.3% vs. 33.8%, both p<0.001). Elevated CA125 (HR 1.93; 95% CI [1.32-2.83]; p=0.001) was associated with a higher HR (hazard ratio) than NTproBNP≥3900 pg/mL (HR 1.71; 95% CI [1.19-2.48]; p=0.004) after adjusting for established risk factors. Elevated CA125 still independently predicted adverse events when CA125 and NTproBNP entered the same multivariate model. Furthermore, risk reclassification analyses demonstrated significant improvements in NRI of 22.3% (p=0.014) and IDI of 2.7% (p=0.012) when adding CA125 to the base model + NTproBNP. Elevated CA125 and NTproBNP predicted adverse outcomes in AHF patients. CA125 added prognostic value to NTproBNP; thus, their combination conferred greater predictive capacity.

Keywords : carbohydrate antigen 125; risk prediction; N-terminal pro-B-type natriuretic peptide; acute heart failure.

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