Carbohydrate antigen 125 trajectories during the transitional phase predict short-term outcomes after admission for...

The early postdischarge period after acute heart failure (AHF) hospitalization is marked by high rates of rehospitalization and death, largely driven by residual congestion. Carbohydrate antigen 125 (CA125) is a congestion-sensitive biomarker, yet the prognostic value of its longitudinal trajectory after AHF remains poorly characterized. We aimed to determine whether serial CA125 measurements during the first 6 months postdischarge predict heart failure (HF) rehospitalization and all-cause mortality.

This single-center cohort study included 3980 consecutive AHF patients (October 2008-February 2023) with 6975 serial CA125 measurements (median follow-up, 161.5 days). Log-transformed CA125 trajectories were modeled using spline-fitted joint models linking longitudinal biomarker evolution with recurrent HF rehospitalizations (joint frailty model) and all-cause mortality (Weibull hazard), with adjustment for established clinical covariates.

During follow-up, 814 rehospitalizations occurred in 549 patients (20.5%) and there were 604 deaths (15.2%). CA125 displayed a biphasic trajectory: an early postdischarge peak around day 10, a steep decline within the first month, and a gradual reduction thereafter (P <.001). In joint modeling, each log-unit increase in CA125 was associated with a 27% higher risk of recurrent HF rehospitalization (HR, 1.27; 95%CI, 1.17-1.37; P <.001), an association that remained constant over time. The association with mortality was time-dependent (P for interaction <.001), strongest within the first 60 days (HR, ∼1.70), and nonsignificant thereafter.

In patients with AHF, serial CA125 measurements display a distinct postdischarge trajectory and independently predict recurrent HF rehospitalizations and early mortality. These findings support the integration of CA125 monitoring into postdischarge management to guide risk stratification and decongestive therapy.