Antigen carbohydrate 125 and brain natriuretic peptide serial measurements for risk stratification following an episode of acute heart failure

BackgroundThe prognostic utility of combining serial measurements of brain natriuretic peptide (BNP) and antigen carbohydrate 125 (CA125) is largely unknown. The aim of this work is to assess the prognostic utility of serial measurements of BNP, CA125, and their optimal combination for predicting long-term mortality, following a hospitalization for acute heart failure (AHF).Methods and resultsWe analyzed 293 consecutive patients admitted with AHF where CA125 and BNP were measured at discharge (T1) and at the first ambulatory visit (T2: median 31 days after discharge). Biomarkers were evaluated as snapshot determinations or as serial changes in absolute, relative or categorical changes and related to subsequent mortality with Cox regression analysis. The incremental prognostic value added by each biomarker was evaluated by the integrated discrimination improvement (IDI) index. During a median follow-up of 18 months, 91 deaths (31.1%) were identified. From the different metrics tested, the categorical changes in CA125 (Normalization: decreasing to ≤ 35 U/ml at T2; Decreasing but not normalization: decreasing but T2 > 35 U/ml; small-increase: increasing but T2 ≤ 35 U/ml and; high-increase: increasing and T2 > 35 U/ml) showed the best discriminative accuracy. For BNP none of the serial changes metrics tested were superior to a single determination at T2 (BNP ≥ 100 pg/ml). Adding these two biomarkers characterization to the clinical model, resulted in a 9.21% (p < 0.001) gain in IDI index.ConclusionsIn patients discharged for AHF, CA125 modeled as a pre–post categorical change, and BNP as a single determination at T2, resulted in the best marker combination for predicting all-cause mortality.