Published online Apr 26, 2014. doi: 10.4330/wjc.v6.i4.205
Revised: March 7, 2014
Accepted: March 13, 2014
Published online: April 26, 2014
AIM: To study the prognostic value of carbohydrate antigen 125 (CA125) and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable heart failure (HF) patients.
METHODS: The predictive value of CA125 was retrospectively assessed in 156 patients with stable HF remitted to the outpatient HF unit for monitoring from 2009 to 2011. Patients were included in the study if they had a previous documented episode of HF and received HF treatment. CA125 and NT-proBNP concentrations were measured. The independent association between NT-proBNP or CA125 and mortality was assessed with Cox regression analysis, and their combined predictive ability was tested by the integrated discrimination improvement (IDI) index.
RESULTS: The mean age of the 156 patients was 72 ± 12 years. During follow-up (17 ± 8 mo), 27 patients died, 1 received an urgent heart transplantation and 106 required hospitalization for HF. Higher CA125 values were correlated with outcomes: 58 ± 85 KU/L if hospitalized vs 34 ± 61 KU/L if not (P < 0.05), and 94 ± 121 KU/L in those who died or needed urgent heart transplantation vs 45 ± 78 KU/L in survivors (P < 0.01). After adjusting for propensity scores, the highest risk was observed when both biomarkers were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001) and intermediate when only NT-proBNP was elevated vs not elevated (HR = 4.15, 95%CI: 1.41-12.24; P < 0.01). Moreover, when CA125 was added to the clinical model with NT-proBNP, a 4% (P < 0.05) improvement in the IDI was found.
CONCLUSION: CA125 > 60 KU/L identified patients in stable HF with poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.
Core tip: Increased carbohydrate antigen 125 (CA125) has prognostic implications in acute heart failure (HF). The aim of this study was to assess the prognostic value of increased CA125 and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable HF patients. Higher CA125 values correlated with outcomes. The highest risk was observed when both biomarkers CA125 and NT-proBNP were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001). CA125 > 60 KU/L identified patients in stable HF with very poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.