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

TY - JOUR

T1 - Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

AU - Núñez, Julio

AU - Bayés-Genís, Antoni

AU - Revuelta-López, Elena

AU - Miñana, Gema

AU - Santas, Enrique

AU - ter Maaten, Jozine M.

AU - de la Espriella, Rafael

AU - Carratalá, Arturo

AU - Lorenzo, Miguel

AU - Palau, Patricia

AU - Llàcer, Pau

AU - Valle, Alfonso

AU - Bodí, Vicent

AU - Núñez, Eduardo

AU - Lupón, Josep

AU - Lang, Chim

AU - Ng, Leong L.

AU - Metra, Marco

AU - Sanchis, Juan

AU - Voors, Adriaan A.

N1 - BIOSTAT-CHF was funded by the European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010-020808-29] and CIBER Cardiovascular (16/11/00420 and 16/11/00403).

PY - 2022/4/1

Y1 - 2022/4/1

N2 - 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.

AB - 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.

KW - CA125

KW - antigen carbohydrate 125

KW - Worsening Heart Failure

KW - Congestion

KW - Outcome

U2 - 10.1016/j.rec.2021.02.002

DO - 10.1016/j.rec.2021.02.002

M3 - Article

C2 - 33745912

SN - 0300-8932

VL - 75

SP - 316

EP - 324

JO - Revista Española de Cardiología

JF - Revista Española de Cardiología

IS - 4

ER -