Modulating effect of carbohydrate antigen 125 on the prognostic value of high-sensitivity C-reactive protein in heart failure
J Montiel Perez, E Santas, A Marti-Martinez, E Revuelta-Lopez, S Villar, R De La Espriella, P Palau, P Llacer, G Minana, E Rodriguez-Borja, A Carratala, A Gonzalez, A Bayes-Genis, J Sanchis, J NunezAbstract
Aims
Inflammation and congestion are key pathophysiological processes in heart failure (HF). Our aim was to evaluate the potential modulatory effect of carbohydrate Antigen 125 (CA125) on inflammation, assessed by high-sensitivity C-reactive protein (hsCRP).
Methods
We analyzed a cohort of 4,043 consecutive patients in whom hsCRP and CA125 levels were measured during a hospitalization for acute HF. Multivariate Cox regression models were applied to assess the association between the biomarkers and all-cause mortality and death/HF rehospitalization at 6 months.
Results
In multivariable analysis, a significant interaction between hsCRP and CA125 was observed for both outcomes (p-value for interaction =0.036 and <0.001, respectively). hsCRP was significantly associated with an increased risk of death (HR = 1.27; 95% CI 1.16–1.41; p < 0.001) and death/HF rehospitalization (HR = 1.18; 95% CI 1.09–1.28; p < 0.001) if CA125 >35 U/mL. In contrast, hsCRP was not predictive of events when CA125 ≤35 U/mL.
Conclusions
In conclusion, in patients with acute HF, the association between hsCRP and clinical outcomes was modulated by CA125 levels. hsCRP was associated with a higher risk of events only in patients with elevated CA125. These findings support a potential modulatory and amplifying role for CA125 in the inflammatory response in HF.Kaplan-Meier hs-CRP and CA125For image description, please refer to the figure legend and surrounding text.6 month-death and composite associationsFor image description, please refer to the figure legend and surrounding text.