Carbohydrate Antigen 125 as a Marker of Decongestion and Early Outcomes in Acute Decompensated Heart Failure:...

Acute decompensated heart failure (ADHF) is a major cause of morbidity and mortality, with congestion being the primary reason for hospitalization. Despite treatment, many patients are discharged with residual congestion, hence the growing interest in utilizing biomarkers as objective tools to guide decongestion therapy. Carbohydrate Antigen 125 (CA125) has emerged as a promising biomarker of systemic congestion, with potential advantages over routine markers. This study evaluated the relationship between CA125 changes and clinical congestion score (CCS) at discharge and assessed its association with 30-day outcomes.

This was a prospective cohort study conducted over seven months at Moi Teaching and Referral Hospital, a tertiary hospital in Western Kenya. Patients with ADHF were enrolled. CA125 levels were measured at admission and discharge using an automated immunoassay. In addition, other markers of congestion, i.e., CCS, NT-proBNP levels, body weight, and inferior vena cava (IVC) diameter, were assessed at both admission and discharge. The 30-day outcomes, which included all-cause mortality and heart failure (HF) rehospitalizations, were recorded. Statistical analyses included correlation and generalized linear models.

A total of 213 patients were included, with an in-hospital mortality rate of 23.5%. There was a significant correlation between changes in CA125 levels and improvements in CCS at discharge (p = 0.018). Patients with in-hospital CA125 reductions had lower rates of the composite 30-day outcome (all-cause mortality or HF rehospitalization) at 15%, compared to 40% in those with rising CA125 levels.

A reduction in CA125 levels during hospitalization is associated with better clinical decongestion and improved short-term outcomes.