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Antigen carbohydrate 125 as a prognostic biomarker in patients with stable chronic heart failure
Paula Guedes Ramallo1, Marina Martínez Moreno2,3, Andrea Romero Valero2,3
1Department of Cardiology, University Hospital of Canary Islands, Tenerife, Spain.
Insights
In stable heart failure with reduced ejection fraction (HFrEF), elevated Carbohydrate Antigen 125 (CA125) levels predict increased hospitalizations and mortality. This biomarker may indicate residual congestion and inflammation in chronic HFrEF patients.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Carbohydrate Antigen 125 (CA125) is linked to poor outcomes in acute heart failure (HF).
- Its prognostic role in chronic, stable heart failure with reduced ejection fraction (HFrEF) remains unclear.
- This study investigated CA125's value in predicting outcomes in clinically stable HFrEF patients.
Purpose of the Study:
- To determine the prognostic significance of plasma CA125 levels.
- To assess CA125's association with mortality and hospital admissions in stable HFrEF.
- To explore CA125 as a potential marker for residual congestion and inflammation.
Main Methods:
- A prospective cohort study of 116 stable HFrEF patients followed for 18 months.
- Stability defined as no HF admissions or IV diuretic use for six months prior.
- Outcomes included all-cause mortality, HF admissions, and cardiovascular (CV) admissions.
- Famoye bivariate Poisson regression analyzed CA125 association with hospitalizations.
Main Results:
- Higher CA125 levels (>9.15 U/mL) were associated with increased HF admissions (IRR 2.49) and CV admissions (IRR 1.88).
- Elevated CA125 showed a non-linear association with increased mortality risk (P=0.02).
- CA125 correlated with lower serum sodium, larger inferior vena cava diameter, and higher inflammatory markers.
Conclusions:
- In stable chronic HFrEF, elevated plasma CA125 predicts increased mid-term morbidity and mortality.
- CA125 may serve as a surrogate marker for residual congestion and inflammation.
- This finding highlights CA125's potential clinical utility in managing stable HFrEF.
Background:
Carbohydrate antigen 125 (CA125) has been associated with a higher risk of mortality and readmission after an acute heart failure (HF) episode. However, the utility of CA125 in evaluating prognosis in chronic and stable HF is not yet established. The aim of this prospective study was to assess whether there is prognostic value of plasma CA125 in chronic HF population with reduced ejection fraction (HFrEF) after a long period of clinical stability.
Methods:
Prospective cohort study that included consecutive patients with stable HFrEF who were followed in the outpatient HF clinic of the General University Hospital of Elche (Alicante, Spain) between July 2018 and January 2019. Stability was defined as the absence of hospital admissions due to HF symptoms or use of intravenous diuretics for at least six months before the inclusion date. The primary outcome was all-cause mortality related to CA125. The secondary endpoints were HF admissions and total cardiovascular (CV) admissions. The association between CA125 and recurrent hospitalizations was evaluated by the Famoye bivariate Poisson regression model.
Results:
The study included 116 patients [69±12 years, 71.6% males, left ventricular ejection fraction 33.4%±7.1%; 52.6% in New York Heart Association class I (indicating long-term stability)]. The median CA125 value was 9.15 U/mL [interquartile range (IQR), 6.15-14.08 U/mL]. During a median follow-up of 18 months (IQR, 13-19 months), there were 13 deaths, 47 HF admissions, and 60 CV admissions. After multivariate adjustment, patients with CA125 >9.15 U/mL had higher rates of HF admissions [incidence rate ratio (IRR) 2.49; 95% confidence interval (CI): 1.14-5.44; P=0.02] and CV admissions (IRR 1.88; 95% CI: 1.01-3.52; P=0.04) compared with those with lower levels. Higher CA125 values were also associated with an increased risk of mortality in a non-linear fashion (P=0.02). Additionally, CA125 levels correlated with serum sodium (P<0.001), inferior vena cava diameter (P=0.03), and inflammatory status (P=0.01).
Conclusions:
In patients with stable chronic HFrEF, higher plasma CA125 was associated with an increase in the burden of mid-term morbidity and mortality. CA125 could be a surrogate marker of residual congestion and inflammatory activity in this particular scenario.
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