Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

Area of Science:

• Cardiology
• Biomarkers
• Clinical Risk Stratification

Background:

• Carbohydrate Antigen 125 (CA125) is a valuable biomarker for risk stratification in patients with acute heart failure (AHF).
• Accurate identification of low-risk patients is crucial for optimizing post-discharge care strategies.

Purpose of the Study:

• To establish a specific CA125 cutoff value for identifying patients with AHF at low risk of 1-month mortality or the composite outcome of death/heart failure readmission.
• To validate this cutoff in an external cohort to confirm its predictive accuracy.

Main Methods:

• A derivation cohort of 3231 AHF patients was analyzed to identify CA125 cutoff values with high negative predictive value (NPV) and sensitivity.
• The optimal cutoff was selected based on its ability to predict 1-month adverse events and validated in an independent cohort of 1583 AHF patients from BIOSTAT-CHF.
• Multivariate survival analyses and the Royston-Parmar method were employed to assess risk prediction.

Main Results:

• An optimal CA125 cutoff of <23 U/mL was identified, present in 21.5% of the derivation cohort.
• This cutoff demonstrated high NPVs: 99.3% for death and 94.1% for the composite endpoint (death/HF readmission) at 1 month.
• CA125 <23 U/mL was independently associated with significantly lower risks of death and the composite endpoint, a finding consistent in the validation cohort with NPVs of 98.6% and 96.6% respectively.

Conclusions:

• A CA125 level below 23 U/mL effectively identifies a subgroup of AHF patients at low risk for short-term adverse events.
• This low-risk population may benefit from less intensive post-discharge monitoring, potentially improving resource allocation.
• The predictive value of this CA125 cutoff extends to 6 months of follow-up, reinforcing its utility in risk stratification.