Incremental power of the combination of brain natriuretic peptide and tumoral antigen carbohydrate 125 for risk stratification in patients with acute heart failure

Introduction

Brain natriuretic peptide (BNP) is a biochemical marker for risk stratification in heart failure, and carbohydrate (CA) 125 has been shown to correlate with heart failure severity. However, few data are available about the combination of these two biomarkers in the evaluation of short-term mortality in patients admitted for acute heart failure (AHF).

Methods

We studied 184 consecutive patients admitted to our ICU for AHF. The CA 125 and BNP levels were measured, and four categories were formed: CI = BNP < 350 ng/l, CA 125 < 65 U/ml; CII = BNP ≥ 350 ng/l, CA 125 < 65 U/ml; CIII = BNP < 350 ng/l, CA 125 ≥ 65 U/ml; and CIV = BNP ≥ 350 ng/l, CA 125 ≥ 65 U/ml. The independent association between the aforementioned categories and survival was assessed with Cox regression analysis.

Results

At 6 months follow-up, 39 deaths (21.2%) were identified. The mortality rate was lower in CI (8.2%), intermediate in CII and CIII (27% and 25.2%, respectively) and higher in CIV (41.8%). After adjusting for age, gender, NYHA class, ejection fraction, systolic blood pressure on admission, sodium and creatinine, the mortality rate remained unaltered. The higher mortality was observed when both biomarkers were elevated (CIV vs CI: heart rate = 3.6, 95% CI: 1.5–8.84). Intermediate risk when only one of them was elevated (CII vs CI: heart rate = 2.2, 95% CI: 0.94–6.4). The lower mortality was observed in the group with none of the biomarkers elevated (CI = control group).

Conclusion

CA 125 added prognostic value to BNP, and the combination of these biomarkers affords a better risk stratification in patients admitted with AHF.