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CA125: a novel cardiac biomarker for infants with congenital diaphragmatic hernia
Lukas Schroeder1, Flaminia Pugnaloni2, Ramona Dolscheid-Pommerich3
1Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany. lukas.schroeder@ukbonn.de.
Insights
Carbohydrate antigen 125 (CA125) shows promise as a biomarker in infants with congenital diaphragmatic hernia (CDH). Elevated CA125 levels predict the need for ECMO and in-hospital mortality in these infants.
Area of Science:
- Neonatal Medicine
- Cardiology
- Biomarker Research
Background:
- Carbohydrate antigen 125 (CA125) is a known cardiac biomarker in adults.
- Limited data exists on CA125's utility in neonatal populations.
- This study is the first to investigate CA125 in infants with congenital diaphragmatic hernia (CDH).
Purpose of the Study:
- To evaluate CA125 as a biomarker for risk stratification in infants with CDH.
- To determine the correlation of CA125 with disease severity and outcomes in CDH infants.
- To assess CA125's predictive value for ECMO and mortality in this cohort.
Main Methods:
- Prospective enrollment of 68 infants with CDH.
- CA125 levels measured at multiple time points: 6, 12, 24, 48 hours, and daily during ECMO (days 1-7).
- Correlation analysis with echocardiographic markers and clinical outcomes (ECMO, mortality).
Main Results:
- Higher CA125 levels at day 1 (6, 12, 24h) were observed in non-surviving infants.
- Infants requiring ECMO had significantly higher CA125 at 12h.
- CA125 levels correlated significantly with pulmonary hypertension and ventricular dysfunction.
- An optimal cutoff of ≥10 U/ml predicted ECMO and mortality.
Conclusions:
- CA125 levels correlate with echocardiographic markers of PH and ventricular dysfunction in CDH infants.
- CA125 is a significant predictor of ECMO need and in-hospital mortality.
- The findings support the routine use of cardiac biomarkers in at-risk neonates.
Background:
The carbohydrate antigen 125 (CA125) was proven as a robust biomarker for risk stratification in adults with heart failure. This is the first study analyzing CA125 in a cohort of infants with congenital diaphragmatic hernia (CDH).
Methods:
Sixty-eight infants with CDH, treated at the University Children's Hospital Bonn (Germany), between January 2018 and February 2021, were prospectively enrolled for analysis. CA125 values were measured at the following timepoints: 6,12, 24, 48 h, and during ECMO daily from day 1 to day 7.
Results:
In infants not surviving to discharge, CA125 values were significantly higher at day 1 (6, 12, and 24 h). Infants with subsequent need for ECMO presented significantly higher CA125 values at 12 h of life. During ECMO, CA125 values measured at day 1 were significantly higher in infants not surviving to discharge. In the ROC analysis, a CA125 value of ≥10 U/ml was calculated as optimal cut-off for the prediction of ECMO and in-hospital mortality. CA125 values correlated significantly with the severity of PH and ventricular dysfunction.
Conclusions:
CA125 values correlate significantly with echocardiographic markers of PH and ventricular dysfunction and correlate significantly with parameters of disease severity (need for ECMO, mortality).
Impact:
CA125 was proven as robust cardiac biomarker in adult cohorts. Information about the utility as a biomarker in neonatal cohorts is lacking. This is the first study analyzing CA125 as a cardiac biomarker in a cohort of infants with congenital diaphragmatic hernia (CDH). CA125 correlates significantly with markers of echocardiographic assessment (PH and ventricular dysfunction) in infants with CDH and helps to identify infants at high risk for ECMO and in-hospital mortality. The results underline the need for the inclusion of cardiac biomarkers in the clinical routine in neonates at risk for cardiopulmonary failure.
