OBJECTIVES The aim of this study was to evaluate the association between antigen carbohydrate 125 (CA125) and the risk of 1-year clinical outcomes in patients with worsening heart failure (HF). BACKGROUND CA125 is a widely available biomarker that is up-regulated in patients with acute HF and has been postulated as a useful marker of congestion and risk stratification. METHODS In a large multicenter cohort of patients with worsening HF, either in-hospital or in the outpatient setting, the independent associations between CA125 and 1-year death and the composite of death/HF readmission (adjusted for outcome-specific prognostic risk score [BIOSTAT risk score]) were determined by using the Royston-Parmar method (N = 2,356). In a sensitivity analysis, the prognostic implications of CA125 were also adjusted for a composite congestion score (CCS). Data were validated in the BIOSTAT-CHF (Biology Study to Tailored Treatment in Chronic Heart Failure validation) cohort (N = 1,630). RESULTS Surrogates of congestion, such as N-terminal pro-B-type natriuretic peptide and CCS, emerged as independent predictors of CA125. In multivariable survival analyses, higher CA125 was associated with an increased risk of mortality and the composite of death/HF readmission (p < 0.001 for both comparisons), even after adjustment for the CCS (p < 0.010 for both comparisons). The addition of CA125 to the BIOSTAT score led to a significant risk reclassification for both outcomes (category-free net reclassification improvement = 0.137 [p < 0.001] and 0.104 [p = 0.003] respectively). All outcomes were confirmed in an independent validation cohort. CONCLUSIONS In patients with worsening HF, higher levels of CA125 were positively associated with parameters of congestion. Furthermore, CA125 remained independently associated with a higher risk of clinical outcomes, even beyond a predefined risk model and clinical surrogates of congestion.

中文翻译：

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CA125 在心力衰竭恶化中的临床作用：一项 BIOSTAT-CHF 研究亚分析。

目的 本研究的目的是评估抗原碳水化合物 125 (CA125) 与心力衰竭 (HF) 患者 1 年临床结局风险之间的关联。背景 CA125 是一种广泛可用的生物标志物，在急性 HF 患者中上调，并被假定为充血和风险分层的有用标志物。方法 在一个大型多中心 HF 恶化患者队列中，无论是住院还是门诊，CA125 与 1 年死亡和死亡/HF 再入院的复合（根据结局特异性预后风险评分调整 [ BIOSTAT 风险评分]）通过使用 Royston-Parmar 方法（N = 2,356）确定。在敏感性分析中，CA125 的预后影响也针对综合拥塞评分 (CCS) 进行了调整。数据在 BIOSTAT-CHF（慢性心力衰竭定制治疗生物学研究验证）队列（N = 1,630）中得到验证。结果 充血的替代物，如 N 端 B 型利钠肽前体和 CCS，成为 CA125 的独立预测因子。在多变量生存分析中，更高的 CA125 与死亡风险增加和死亡/HF 再入院的复合相关（两个比较 p < 0.001），即使在调整 CCS 之后（两个比较 p < 0.010）。将 CA125 添加到 BIOSTAT 评分导致两种结果的显着风险重新分类（无类别净重新分类改善分别 = 0.137 [p < 0.001] 和 0.104 [p = 0.003]）。所有结果都在一个独立的验证队列中得到证实。结论 在 HF 恶化的患者中，较高水平的 CA125 与拥塞参数呈正相关。此外，CA125 仍然与较高的临床结果风险独立相关，甚至超出了预定义的风险模型和充血的临床替代物。