Abstract | OBJECTIVES: The aim of this study was to evaluate the association between antigen carbohydrate 125 (CA125) and the risk of 1-year clinical outcomes in patients with worsening heart failure (HF). BACKGROUND: CA125 is a widely available biomarker that is up-regulated in patients with acute HF and has been postulated as a useful marker of congestion and risk stratification. METHODS: In a large multicenter cohort of patients with worsening HF, either in-hospital or in the outpatient setting, the independent associations between CA125 and 1-year death and the composite of death/HF readmission (adjusted for outcome-specific prognostic risk score [BIOSTAT risk score]) were determined by using the Royston-Parmar method (N = 2,356). In a sensitivity analysis, the prognostic implications of CA125 were also adjusted for a composite congestion score (CCS). Data were validated in the BIOSTAT-CHF (Biology Study to Tailored Treatment in Chronic Heart Failure validation) cohort (N = 1,630). RESULTS: Surrogates of congestion, such as N-terminal pro- B-type natriuretic peptide and CCS, emerged as independent predictors of CA125. In multivariable survival analyses, higher CA125 was associated with an increased risk of mortality and the composite of death/HF readmission (p < 0.001 for both comparisons), even after adjustment for the CCS (p < 0.010 for both comparisons). The addition of CA125 to the BIOSTAT score led to a significant risk reclassification for both outcomes (category-free net reclassification improvement = 0.137 [p < 0.001] and 0.104 [p = 0.003] respectively). All outcomes were confirmed in an independent validation cohort. CONCLUSIONS: In patients with worsening HF, higher levels of CA125 were positively associated with parameters of congestion. Furthermore, CA125 remained independently associated with a higher risk of clinical outcomes, even beyond a predefined risk model and clinical surrogates of congestion.
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Authors | Julio Núñez, Antoni Bayés-Genís, Elena Revuelta-López, Jozine M Ter Maaten, Gema Miñana, Jaume Barallat, Adriana Cserkóová, Vicent Bodi, Agustín Fernández-Cisnal, Eduardo Núñez, Juan Sanchis, Chim Lang, Leong L Ng, Marco Metra, Adriaan A Voors |
Journal | JACC. Heart failure
(JACC Heart Fail)
Vol. 8
Issue 5
Pg. 386-397
(05 2020)
ISSN: 2213-1787 [Electronic] United States |
PMID | 32171764
(Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Biomarkers
- CA-125 Antigen
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Topics |
- Aged
- Biomarkers
(blood)
- CA-125 Antigen
(blood)
- Cause of Death
(trends)
- Disease Progression
- Europe
(epidemiology)
- Female
- Heart Failure
(blood, diagnosis, mortality)
- Humans
- Male
- Prognosis
- Prospective Studies
- Risk Assessment
(methods)
- Survival Rate
(trends)
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