Elevated CA125 values predict adverse outcomes in acute heart failure.

Abstract

Abstract. 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 readmis-sion endpoint. The study included 352 patients admitted for AHF. The primary endpoint was the six-month combined endpoint of death/AHF rehospitaliza-tion. 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 multivari-ate Cox regression analysis, and their incremental prognostic utility was evalu-ated 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 cu-mulative 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 NTproB-NP 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.