Carbohydrate antigen 125 determined on arrival at the emergency department correlates with severity of decompensation and adverse outcomes in patients with acute heart failure

Abstract

To investigate the capacity of carbohydrate antigen 125 (CA125) to detect severe decompensation in patients diagnosed with acute heart failure (AHF) in the emergency department (ED) and to predict 1-year mortality. We assessed CA125 at ED arrival in unselected patients diagnosed with AHF in five Spanish hospitals during November-December 2022. CA125 was categorized as tertiles. As markers of severity of decompensation, we assessed MEESSI-AHF score, need for hospitalization, prolonged hospitalization (> 7 days), and in-hospital mortality, while 30-day post-discharge adverse events (ED revisit, hospitalization, or death) and 1-year all-cause mortality were considered as outcomes. Unadjusted and adjusted comparisons among CA125 tertile categories and severity of decompensation and outcomes were performed using logistic and Cox regression. The relationship between CA125 along its continuum and 1-year mortality was also assessed by restricted cubic spline (RCS) curves. We included 429 patients. The median age was 83 years, 57% were female, and the median CA125 was 37 U/mL (IQR: 16-78). After adjustment by age, sex, dementia, sodium, and NT-proBNP, the need for hospitalization was higher in those in the upper tertile (> 55.8 U/ml) vs the lowest tertile (< 22.4 U/ml) of CA125 (OR = 1.996, 95% CI 1.092-3.647). Similarly, under the same multivariate setting, the upper CA125 tertile was associated with higher 1-year mortality (OR = 2.271, 95%CI 1.272-4.052). The RCS model showed that 1-year mortality steadily increased until 100 U/ml. At higher values, there was a softer increase. CA125 determined on arrival at the ED in patients with AHF could help to determine the severity of decompensation and is associated with a higher risk of death during the following year after decompensation.

Keywords: Death; Emergency department; Heart failure; Risk management.