Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). 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.
Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). 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 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a cohort of patients hospitalized from BIOSTAT-CHF (n = 1583). Results: In the derivation cohort, the median [IQR] CA125 was 57 [25.3-157] U/mL. The optimal cutoff value was < 23 U/mL (21.5% of patients), with NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. On multivariate survival analyses, CA125 < 23 U/mL was independently associated with a lower risk of death (HR, 0.20; 95%CI, 0.08-0.50; P < .001), and the combined endpoint (HR, 0.63; 95%CI, 950.45-0.90; P = .009). The ability of this cutpoint to discriminate patients at a low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for death and the composite endpoint). The predicted ability of this cutoff remained significant at 6 months of follow-up. Conclusions: In patients admitted with AHF, CA125 < 23 U/mL identified a subgroup at low risk of short-term adverse events, a population that may not require intense postdischarge monitoring. Full English text available from:www.revespcardiol.org/en
Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure / Núñez, Julio; Bayés-Genís, Antoni; Revuelta-López, Elena; Miñana, Gema; Santas, Enrique; Ter Maaten, Jozine M; De La Espriella, Rafael; Carratalá, Arturo; Lorenzo, Miguel; Palau, Patricia; Llàcer, Pau; Valle, Alfonso; Bodi, Vicent; Núñez, Eduardo; Lupón, Josep; Lang, Chim; Ng, Leong L; Metra, Marco; Sanchis, Juan; Voors, Adriaan A. - In: REVISTA ESPAÑOLA DE CARDIOLOGÍA. - ISSN 1885-5857. - 75:4(2022), pp. 316-324. [10.1016/j.recesp.2021.01.023]
Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure
Metra, Marco;
2022-01-01
Abstract
Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). 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 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a cohort of patients hospitalized from BIOSTAT-CHF (n = 1583). Results: In the derivation cohort, the median [IQR] CA125 was 57 [25.3-157] U/mL. The optimal cutoff value was < 23 U/mL (21.5% of patients), with NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. On multivariate survival analyses, CA125 < 23 U/mL was independently associated with a lower risk of death (HR, 0.20; 95%CI, 0.08-0.50; P < .001), and the combined endpoint (HR, 0.63; 95%CI, 950.45-0.90; P = .009). The ability of this cutpoint to discriminate patients at a low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for death and the composite endpoint). The predicted ability of this cutoff remained significant at 6 months of follow-up. Conclusions: In patients admitted with AHF, CA125 < 23 U/mL identified a subgroup at low risk of short-term adverse events, a population that may not require intense postdischarge monitoring. Full English text available from:www.revespcardiol.org/enI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
