Prognostic value of increased carbohydrate antigen in patients with heart failure.
OBJECTIVE
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.


CONCLUSIONS
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.
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Ana B
AB
Méndez
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Jordi
J
Ordoñez-Llanos
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Andreu
A
Ferrero
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Mariana
M
Noguero
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Teresa
T
Mir
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Josefina
J
Mora
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Antoni
A
Bayes-Genis
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Sònia
S
Mirabet
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Juan
J
Cinca
Ana B Méndez, Andreu Ferrero, Mariana Noguero, Sònia Mirabet, Juan Cinca, Eulàlia Roig, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau and Universitat Autònoma, 08041 Barcelona, Spain.
Eulàlia
E
Roig
Brain natriuretic peptides; Carbohydrate antigen 125; Heart failure; Prognosis; Survival