Key result
Elevated CA125 and BNP linked to ~4-fold higher 6-month mortality in acute heart failure.
Why the study?
Elevated BNP and CA125 predict adverse outcomes in acute heart failure, but whether combining them improves prognostic utility was unexplored.
Does the combination of CA125 and BNP improve risk stratification for 6-month all-cause mortality in patients with acute heart failure?
Cohort (n=1,111)
Does the combination of CA125 and BNP improve risk stratification for 6-month all-cause mortality in patients with acute heart failure?
Answers are grounded in this paper and cite their sources.
The combination of CA125 and BNP significantly improves 6-month mortality risk stratification in patients admitted with acute heart failure compared to BNP alone.
AIM: Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought to assess whether CA125 adds prognostic value to BNP in predicting 6-month all-cause mortality in patients with AHF. METHODS AND RESULTS: We analysed 1111 consecutive patients admitted for AHF. Antigen carbohydrate 125 (U/mL) and BNP (pg/mL) were measured at a median of 72 +/- 12 h after instauration of treatment. Antigen carbohydrate 125 and BNP were dichotomized based on proposed prognostic cutpoints, and a variable with four categories was formed (BNP-CA125): C1 = BNP < 350 and CA125 < 60 (n = 394); C2 = BNP > or = 350 and CA125 < 60 (n = 165); C3 = BNP < 350 and CA125 > or = 60 (n = 331); and C4 = BNP > or = 350 and CA125 > or = 60 (n = 221). The independent association between BNP-CA125 and mortality was assessed with the Cox regression analysis, and their added predictive ability tested by the integrated discrimination improvement (IDI) index. At 6 months, 181 deaths (16.3%) were identified. The cumulative rate of mortality was lower for patients in C1 (7.8%), intermediate for C2 and C3 (17.8% and 16.9%, respectively), and higher for C4 (37.2%), and P-value for trend <0.001. After adjusting for established risk factors, the highest risk was observed when both biomarkers were elevated (C4 vs. C1: HR = 4.05, 95% CI = 2.54-6.45; P < 0.001) and intermediate when only one of them was elevated: (C2 vs. C1: HR = 1.71, 95% CI = 1.00-2.93; P = 0.050) and (C3 vs. C1: HR = 2.10, 95% CI = 1.30-3.39; P = 0.002). Moreover, when CA125 was added to the clinical model + BNP, a 10.4% (P < 0.0001) improvement in the IDI (on the relative scale) was found. CONCLUSION: In patients admitted with AHF, CA125 added prognostic value beyond the information provided by BNP, and thus, their combination enables better 6-month risk stratification.
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Núñez et al. (2010) conducted a cohort in acute heart failure (AHF) (n=1,111). Elevated CA125 and BNP (BNP ≥350 pg/mL and CA125 ≥60 U/mL) vs. Low CA125 and BNP (BNP <350 pg/mL and CA125 <60 U/mL) was evaluated on 6-month all-cause mortality (HR 4.05, 95% CI 2.54-6.45, p=<0.001). In patients with acute heart failure, the combination of elevated CA125 and BNP was associated with a significantly higher risk of 6-month mortality compared to low levels of both (HR 4.05; 95% CI 2.54-6.45; P<0.001).
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