Admission Ca-125 to identify diuretic response in hospitalized patients with acute decompensated heart failure

Elevated circulating cancer antigen-125 (Ca-125) in heart failure has been proposed as a congestive and prognostic biomarker for patients with acute decompensated heart failure (ADHF). However, the relationship between circulating Ca-125 and diuretic efficiency in this population remains unknown.

We hypothesized that hospitalized ADHF patients with increased circulating Ca-125 levels are prone to high risk for the development of insufficient diuretic response.

We conducted the Receiver operator characteristics (ROC) analysis and binary logistic regression analysis to reveal the association between circulating Ca-125 level and diuretic response in hospitalized patients with ADHF. Insufficient diuretic response was defined as (1) a spot urinary Na+ <50 mEq/L in the spot urine sample collected 2 h following loop diuretic administration, and (2) <100 mL/hour diuresis after loop diuretic administration.

In the prospective observational cohort study, we enrolled 168 hospitalized patients with ADHF. Insufficient diuretic response and worsening renal function occurred in 45 (26.8 %) and 83 (49.4 %) patients, respectively. ROC analysis revealed that the optimal cut off of Ca-125 was 97.6 U/mL with a sensitivity of 64 %, and a specificity of 78 %. Overall model quality was 0.60. Using the binary logistic regression model, Ca-125≥97.6 U/mL (OR: 6.238, 95 %CI:2.712-14.349) and creatinine (OR: 4.194, 95 %CI:1.162-15.131) were independent predictors for the development of insufficient diuretic response.

In hospitalized patients with ADHF, Ca-125 ≥ 97.6 U/mL can be an effective sign in forecasting diuretic efficiency and may contribute to a better risk stratification for the development of insufficient diuretic response.