Clinical Role of CA125 in Worsening Heart Failure

Abstract

Objectives. This work aims 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 BIOSTAT risk score) were determined with the Royston-Parmar method (n=2356). In a sensitivity analysis, the prognostic implications of CA125 were also adjusted for a clinical congestion score (CCS). Data were validated in the BIOSTAT-CHF validation cohort (n=1630). Results. Surrogates of congestion, such as NT-proBNP and a 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.

Additive prognostic value of carbohydrate antigen‐125 over frailty in patients undergoing transcatheter aortic valve replacement

“…Recently, in patients with worsening heart failure, circulating levels of CA‐125 were independently and positively associated with clinical surrogates of congestion such as NT‐proBNP and composite congestion score (CCS). Their levels were also predictive of both 1‐year all‐cause mortality and readmissions for CHF 25 …”

Biomarkers for the diagnosis and management of heart failure

“…Since then, numerous studies have investigated this association, highlighting the prognostic value of CRP, tumor necrosis factor alpha (TNFα), and interleukin-6 (IL-6) in chronic HF [99]. The elevation of these 3 biomarkers has also been associated with an increased risk of HF development in elderly subjects [100,101]. Recently, cancer antigen 125 (CA-125) has attracted some attention.…”

Prognostic significance of carbohydrate antigen 125 in acute heart failure: a prospective comparative study with N-terminal pro-B-type natriuretic peptide

“…Suitable biomarkers would optimize risk prediction. CA125 levels correlate well with signs of uid congestion 9,10,16 and pulmonary artery wedge pressure 10,16 . In this study, the most important clinical predictor of serum CA125 levels was the presence of pleural effusion.…”

“…As a marker of congestion, CA125 being related with adverse events in heart failure patients 9,10 , has been shown to be indicative as a heart failure severity surrogate. Elevated CA125 is an independent predictor with incremental prognostic value over traditional prognosticators and natriuretic peptides 9 , and thus, combining both biomarkers improved risk strati cation in AHF 10 . Interestingly, although CA125 has shown to be a potential tool for treatment guiding in AHF 12,24 , little support is available regarding the bene ts of NP-guided therapy over usual care 25 .…”

“…In this study, the most important clinical predictor of serum CA125 levels was the presence of pleural effusion. As a marker of congestion, CA125 being related with adverse events in heart failure patients 9,10 , has been shown to be indicative as a heart failure severity surrogate. Elevated CA125 is an independent predictor with incremental prognostic value over traditional prognosticators and natriuretic peptides 9 , and thus, combining both biomarkers improved risk strati cation in AHF 10 .…”