Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure

Núñez, Julio; Sanchís, Juan; Bodı́, Vicent; Fonarow, Gregg C.; Núñez, Eduardo; Bertomeu-González, Vicente; Miñana, Gema; Consuegra, Luciano; Bosch, María José; Carratalá, Arturo; Chorro, Francisco J.; Llàcer, Àngel

doi:10.1093/eurheartj/ehq142

Cited by 113 publications

(98 citation statements)

References 31 publications

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“…In fact, when both biomarkers were elevated, the prognosis was very poor. In another recent study performed in stable patients with left ventricular dysfunction, a value of CA125 ≥ 60 KU/L was associated with an increased risk of cardiovascular death and hospitalization for HF [22] . Our study did not select patients according to the degree of left ventricular dysfunction; all patients diagnosed with HF were included.…”

Section: Previous Studiesmentioning

confidence: 89%

“…Without a clear cut-off for NT-proBNP in the literature, 3100 ng/L was selected because it was close to the mean NTproBNP value of our population and it had the best cutoff according to area under the curve (AUC) calculation, with a sensitivity of 62% and a specificity of 82% to predict mortality. A CA125 cut-off of 60 KU/L was used, in keeping with the best predictor of mortality identified by a previous study in patients with acute HF [22] . Based on these data, a new dichotomous variable was created for a CA125 value of 60 KU/L.…”

Section: Discussionmentioning

confidence: 99%

“…Few of the studies focus on stable chronic HF [37,38] . Earlier studies in acute HF patients associated increased CA125 with worse NYHA functional class, greater left atrial size, higher BNP, and poor prognosis at 6 mo follow-up [19,20,22] . A recent study by Ordu et al [37] reports that increased CA125 and NT-proBNP were similar in their capacity to predict prognosis in patients with stable HF [38] .…”

Section: Previous Studiesmentioning

confidence: 99%

“…Although its release mechanisms are not yet well understood, they correlate with increased left ventricular end-diastolic pressure, higher BNP level, and worse New York Heart Association (NYHA) functional class [20,21] . Moreover, previous studies of BNP and CA125 in acute HF have demonstrated an additive prognostic value of CA125; therefore, the determination of both biomarkers would improve risk stratification [22] . The advantages of CA125 determination with respect to natriuretic peptides are its higher stability in the circulation and lower cost [23] .…”

Section: Introductionmentioning

confidence: 99%

“…The advantages of CA125 determination with respect to natriuretic peptides are its higher stability in the circulation and lower cost [23] . The usefulness of CA125 measurement to assess prognosis in patients admitted with acute decompensated HF has been previously demonstrated [19][20][21][22] . However, information is lacking on its value in assessing the prognosis of patients with stable chronic HF.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of increased carbohydrate antigen in patients with heart failure

Méndez

Ordóñez-Llanos

Ferrero

et al. 2014

WJC

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Author contributions: Mendez AB contributed to design of the study, analysis and interpretation of data, manuscript writing and final approval of manuscript; Ordoñez-Llanos J contributed to analysis of data, review of CA125 and NT-proBNP determinations and substantial contribution to manuscript review; Ferrero A contributed to statistical assessment and substantial contribution to manuscript review; Noguero M contributed to patient selection and follow-up, Serotec and analysis of data; Mir T and Mora J contributed to CA125 and NT-proBNP determinations, analysis of data, substantial contribution to manuscript; Bayes-Genis A and Mirabet S contributed to patient selection and follow-up, analysis of data, substantial contribution to manuscript; Cinca J contributed to design of the study and substantial contribution to manuscript review; Roig E contributed to design of the study, selection of patients, analysis of data, and substantial contribution to manuscript review. Abstract 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.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Heart failure; Prognosis; Carbohydrate antigen 125; Brain natriuretic peptides; Survival 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 ...

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Section: Previous Studiesmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic value of increased carbohydrate antigen in patients with heart failure

Méndez

Ordóñez-Llanos

Ferrero

et al. 2014

WJC

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Congestive nephropathy: a neglected entity? Proposal for diagnostic criteria and future perspectives

et al. 2020

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Venous congestion has emerged as an important cause of renal dysfunction in patients with cardiorenal syndrome. However, only limited progress has been made in differentiating this haemodynamic phenotype of renal dysfunction, because of a significant overlap with pre‐existing renal impairment due to long‐term hypertension, diabetes, and renovascular disease. We propose congestive nephropathy (CN) as this neglected clinical entity. CN is a potentially reversible subtype of renal dysfunction associated with declining renal venous outflow and progressively increasing renal interstitial pressure. Venous congestion may lead to a vicious cycle of hormonal activation, increased intra‐abdominal pressure, excessive renal tubular sodium reabsorption, and volume overload, leading to further right ventricular (RV) stress. Ultimately, renal replacement therapy may be required to relieve diuretic‐resistant congestion. Effective decongestion could preserve or improve renal function. Congestive acute kidney injury may not be associated with cellular damage, and complete renal function restoration may be a confirmatory diagnostic criterion. In contrast, a persistently low renal perfusion pressure might induce renal dysfunction and histopathological lesions with time. Thus, urinary markers may differ. CN is mostly seen in biventricular heart failure but may also occur secondary to pulmonary arterial hypertension and elevated intra‐abdominal pressure. An increase in central venous pressure to >6 mmHg is associated with a steep decrease in glomerular filtration rate. However, the central venous pressure range that can provide an optimal balance of RV and renal function remains to be determined. We propose criteria to identify cardiorenal syndrome subgroups likely to benefit from decongestive or pulmonary hypertension‐specific therapies and suggest areas for future research.

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CA‐125 variation in acute heart failure: a single‐centre analysis

et al. 2022

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Aims A decrease in carbohydrate antigen 125 (CA-125) predicts survival advantage in chronic heart failure (HF); the impact of its variation in acute HF is unknown. We studied the association of CA-125 decrease with prognosis in acute HF. Methods and resultsWe studied acute hospitalized HF patients. Predictors of admission and discharge CA-125 were determined by linear regression. Follow-up was 1 year; endpoint was all-cause death. The association of admission and discharge CA-125 with mortality was assessed using a Cox-regression analysis. A Cox-regression analysis was also used to assess the prognostic impact of CA-125 decrease during hospitalization. Analysis was stratified by length of hospital stay (LOS). We studied 363 patients, 51.5% male, mean age 75 ± 12 years, 51.5% ischaemic, 30.0% with preserved ejection fraction, and 57.3% with reduced ejection fraction; patients presented elevated comorbidity burden. Median LOS was 7 (5-11) days. In the subgroup of 262 patients with CA-125 measured both at admission and at discharge, we reported a significant increase in its levels: 56.0 (26.0-160.7) U/mL to 74.0 (32.3-195.0) U/mL. Independent predictors of admission CA-125 were higher BNP and lower creatinine. Predictors of discharge CA-125 were higher discharge BNP, lower discharge albumin, and younger age. Both admission and discharge CA-125 predicted mortality. During follow-up, 75 (31.8%) patients died. A decrease in CA-125 predicted a 68% reduction in the 1 year death risk only in patients with LOS > 10 days. Conclusions Our results suggest that an early re-evaluation (>10 days) with CA-125 measurement after an acute HF hospitalization may be of interest in patient management.

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Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure

Abstract: In patients admitted with AHF, CA125 added prognostic value beyond the information provided by BNP, and thus, their combination enables better 6-month risk stratification.

Cited by 113 publications

References 31 publications

Prognostic value of increased carbohydrate antigen in patients with heart failure

Prognostic value of increased carbohydrate antigen in patients with heart failure

Congestive nephropathy: a neglected entity? Proposal for diagnostic criteria and future perspectives

CA‐125 variation in acute heart failure: a single‐centre analysis

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