Chronic obstructive pulmonary disease and CA125 levels in chronic heart failure (COPA-HF Study)
P Cevallos, J Rodriguez, L Soler, M Vergara, E Moreno, M Garcia, M Cobo, C Perez, M Bellver, J Campos, S Castillo, C Beltran, P Llacer, L ManzanoAbstract
Background
Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in chronic heart failure (CHF) and is associated with worse symptoms and a greater congestion burden. Carbohydrate antigen 125 (CA125) has emerged as an integrative biomarker of congestion and inflammation in HF, yet its relationship with COPD in ambulatory CHF remains insufficiently characterized. We aimed to (1) determine the prevalence of COPD in a CHF cohort, (2) compare CA125 levels according to COPD status, and (3) evaluate whether COPD independently predicts CA125 levels.
Methods
We performed a multicenter, prospective observational study including consecutive CHF patients evaluated during scheduled follow-up visits in specialized HF outpatient clinics across our region. COPD was defined using standard spirometric criteria. Baseline characteristics were compared between patients with and without COPD. Categorical variables were expressed as percentages and compared using χ² or Fisher’s exact test; continuous variables were expressed as median (IQR) and compared using the Mann–Whitney U test. Independent predictors of CA125 (U/mL) were identified through multivariable linear regression including age, NT-proBNP, COPD, estimated glomerular filtration rate (eGFR), hemoglobin, systolic blood pressure (SBP), heart rate, clinical edema, inferior vena cava diameter, and pleural effusion.
Results
A total of 171 patients were included, with a COPD prevalence of 35.7% (61/171). Compared with patients without COPD, those with COPD were younger, more frequently male, and had a higher prevalence of diabetes and prior hospitalizations. They exhibited worse functional status (higher proportion in NYHA III), lower oxygen saturation, more B-lines, impaired spirometry (lower FEV1/FVC), higher leukocyte counts, lower serum chloride, and higher CA125 levels, with no significant differences in NT-proBNP levels. (Figure 1). COPD patients more frequently receive MRAs, loop diuretics, and bronchodilators. In multivariable analysis, COPD remained an independent predictor of higher CA125 (β=16.38; 95% CI 3.59–29.17; p=0.013), as did pleural effusion (β=20.42; 95% CI 0.58–40.26; p=0.044). Clinical edema showed a positive but non-significant trend toward higher CA125 levels (β=8.49; 95% CI –2.05 to 19.02; p=0.113). (Figure 2).
Conclusion
In an ambulatory CHF cohort, COPD was common and associated with elevated CA125 levels. This relationship persisted after multivariable adjustment, supporting COPD as an independent determinant of CA125 in CHF. Pleural effusion also independently predicted CA125, reinforcing the value of CA125 as a clinically useful marker of congestion in HF patients with respiratory comorbidity.Distribution of CA125 and NT-proBNPFor image description, please refer to the figure legend and surrounding text.Forest plot of multivariable linearFor image description, please refer to the figure legend and surrounding text.