Clinical Role of CA125 in Worsening Heart Failure: A BIOSTAT-CHF Study Subanalysis

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 (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)386-397
Number of pages12
JournalJACC: Heart Failure
Issue number5
Early online date11 Mar 2020
Publication statusPublished - May 2020


  • CA125
  • carbohydrate antigen 125
  • congestion
  • outcome
  • worsening heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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