Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

Julio Núñez, Antoni Bayés-Genís, Elena Revuelta-López, Gema Miñana, Enrique Santas, Jozine M. ter Maaten, Rafael de la Espriella, Arturo Carratalá, Miguel Lorenzo, Patricia Palau, Pau Llàcer, Alfonso Valle, Vicent Bodí, Eduardo Núñez, Josep Lupón, Chim Lang, Leong L. Ng, Marco Metra, Juan Sanchis, Adriaan A. Voors (Lead / Corresponding author)

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Background: In patients admitted with acute heart failure (AHF), plasma levels of antigen carbohydrate 125 (CA125) have shown to be useful for risk stratification. We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF-readmission following admission for AHF.

Methods: The derivation cohort included consecutive patients admitted with AHF (n=3231). CA125 cut-off values measured during early admission that yielded a 90% negative predictive value (NPV) and sensitivity up to 85% were identified. Then, the adequacy of these cutpoints and the risk of 1-month death/HF-readmission was further tested in the multivariate survival analysis using the Royston-Parmar method. The cutpoint associated with the best-fitted model (using AIC and BIC criteria) was deemed as the optimal cutpoint. The chosen cutpoint was externally validated in a cohort of patients hospitalized from the BIOSTAT-CHF (n=1583).

Results: In the derivation cohort, median (IQR) CA125 was 57 U/mL (25.3-157); The optimal cut-off was < 23 U/ml (21.5% of patients), which yielded a NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. In multivariable survival analyses, a CA125<23 U/mL was independently associated with a lower risk of death (HR=0.20, CI 95%:0.08-0.50;p<0.001) and the combined endpoint (HR=0.63, CI95%:0.45-0.90; p=0.009). The ability of this cutpoint for discriminating patietns at low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for deaths and the composite endpoint). This predicted ability of this cut-off remained significant at 6-month follow-up.

Conclusions: In patients admitted with AHF, patients with CA125<23 U/mL identified a subgroup of patients at low risk of short-term adverse events, a population that may not require intense post-discharge monitoring.
Original languageEnglish
Pages (from-to)316-324
Number of pages9
JournalRevista Española de Cardiología
Issue number4
Early online date19 Mar 2021
Publication statusPublished - 1 Apr 2022


  • CA125
  • antigen carbohydrate 125
  • Worsening Heart Failure
  • Congestion
  • Outcome


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