Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de Valencia, Avda. Blasco Ibáñez 17., 46010 Valencia, Spain.
Eur Heart J. 2010 Jul;31(14):1752-63. doi: 10.1093/eurheartj/ehq142. Epub 2010 May 25.
Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought to assess whether CA125 adds prognostic value to BNP in predicting 6-month all-cause mortality in patients with AHF.
We analysed 1111 consecutive patients admitted for AHF. Antigen carbohydrate 125 (U/mL) and BNP (pg/mL) were measured at a median of 72 +/- 12 h after instauration of treatment. Antigen carbohydrate 125 and BNP were dichotomized based on proposed prognostic cutpoints, and a variable with four categories was formed (BNP-CA125): C1 = BNP < 350 and CA125 < 60 (n = 394); C2 = BNP > or = 350 and CA125 < 60 (n = 165); C3 = BNP < 350 and CA125 > or = 60 (n = 331); and C4 = BNP > or = 350 and CA125 > or = 60 (n = 221). The independent association between BNP-CA125 and mortality was assessed with the Cox regression analysis, and their added predictive ability tested by the integrated discrimination improvement (IDI) index. At 6 months, 181 deaths (16.3%) were identified. The cumulative rate of mortality was lower for patients in C1 (7.8%), intermediate for C2 and C3 (17.8% and 16.9%, respectively), and higher for C4 (37.2%), and P-value for trend <0.001. After adjusting for established risk factors, the highest risk was observed when both biomarkers were elevated (C4 vs. C1: HR = 4.05, 95% CI = 2.54-6.45; P < 0.001) and intermediate when only one of them was elevated: (C2 vs. C1: HR = 1.71, 95% CI = 1.00-2.93; P = 0.050) and (C3 vs. C1: HR = 2.10, 95% CI = 1.30-3.39; P = 0.002). Moreover, when CA125 was added to the clinical model + BNP, a 10.4% (P < 0.0001) improvement in the IDI (on the relative scale) was found.
In patients admitted with AHF, CA125 added prognostic value beyond the information provided by BNP, and thus, their combination enables better 6-month risk stratification.
脑利钠肽（BNP）和肿瘤标志物抗原碳水化合物 125（CA125）水平升高已表明与急性心力衰竭（AHF）患者不良预后风险增加相关。然而，尚未尝试探索联合使用这两种生物标志物的效果。我们旨在评估 CA125 是否可以为 BNP 提供附加的预后价值，从而预测 AHF 患者 6 个月的全因死亡率。
我们分析了 1111 例连续因 AHF 入院的患者。在治疗开始后中位数 72 ± 12 小时测量 CA125（U/mL）和 BNP（pg/mL）。根据提出的预后切点将 CA125 和 BNP 分为两部分，并形成具有四个类别的变量（BNP-CA125）：C1 = BNP < 350 且 CA125 < 60（n = 394）；C2 = BNP >或 = 350 且 CA125 < 60（n = 165）；C3 = BNP < 350 且 CA125 >或 = 60（n = 331）；C4 = BNP >或 = 350 且 CA125 >或 = 60（n = 221）。使用 Cox 回归分析评估 BNP-CA125 与死亡率之间的独立相关性，并使用综合判别改善（IDI）指数测试其附加预测能力。6 个月时，有 181 例死亡（16.3%）。累积死亡率较低的患者为 C1（7.8%），C2 和 C3 为中等（17.8%和 16.9%），C4 为较高（37.2%），趋势 P 值 <0.001。在调整了既定的危险因素后，当两种生物标志物均升高时，观察到最高的风险（C4 与 C1：HR = 4.05，95%CI = 2.54-6.45；P < 0.001），而当仅有一种生物标志物升高时，风险为中等（C2 与 C1：HR = 1.71，95%CI = 1.00-2.93；P = 0.050）和（C3 与 C1：HR = 2.10，95%CI = 1.30-3.39；P = 0.002）。此外，当将 CA125 添加到临床模型+ BNP 中时，IDI（相对比例）提高了 10.4%（P < 0.0001）。
在因 AHF 入院的患者中，CA125 提供了超越 BNP 提供的信息的预后价值，因此，它们的联合使用可以更好地进行 6 个月的风险分层。
