Miñana Gema, de la Espriella Rafael, Lorenzo-Hernández Miguel, Rodriguez-Borja Enrique, Mollar Anna, Palau Patricia, Fernández-Cisnal Agustin, Valero Ernesto, Carratalá Arturo, Santas Enrique, Bodi Vicent, Sanchis Juan, Bayés-Genís Antoni, Nuñez Eduardo, Nuñez Julio
Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
CIBER Cardiovascular, Madrid, Spain.
Cardiorenal Med. 2025;15(1):122-132. doi: 10.1159/000543417. Epub 2025 Jan 8.
Antigen carbohydrate 125 (CA125) has emerged as a proxy of fluid overload and inflammation in acute heart failure (AHF). We aimed to evaluate the influence of dapagliflozin on CA125 levels within the first weeks after discharge and whether CA125 changes were related to 6-month adverse clinical outcomes.
In this retrospective observational study, data from 956 AHF patients discharged from a tertiary hospital were analyzed. CA125 levels were assessed during the index admission (visit 1) and at a median of 26 (15-39) days after discharge (visit 2). The primary endpoint was changes in CA125 and its correlation with the risk of 6-month death and recurrent readmissions (any or AHF-related). Multivariable mixed regression and a two-equation count model regression were used for the analyses.
The mean age of the cohort was 73.1 ± 11.1 years, 54.8% were males, 43.5% showed left ventricular ejection fraction ≥50%, and 18.7% of patients received dapagliflozin at discharge. Dapagliflozin treatment was associated with a greater reduction in CA125 levels at follow-up (-24 U/mL) compared to non-dapagliflozin patients (-14 U/mL, p = 0.034). The magnitude of CA125 reduction (per decrease in 10 U/mL) was significantly associated with a lower risk of 6-month death (incidence rate ratio [IRR] = 0.98, 95% CI = 0.96-0.99; p = 0.049), all-cause readmissions (IRR = 0.99, 95% CI = 0.98-0.99; p = 0.003), and HF readmissions (IRR = 0.98, 95% CI = 0.97-0.99; p < 0.001).
Dapagliflozin treatment at discharge following an episode of AHF was associated with a greater reduction in CA125 during the first weeks after discharge. The greater CA125 reduction identified patients with a lower risk of 6-month adverse clinical outcomes.
抗原碳水化合物125（CA125）已成为急性心力衰竭（AHF）中液体超负荷和炎症的一个替代指标。我们旨在评估达格列净对出院后最初几周内CA125水平的影响，以及CA125的变化是否与6个月时的不良临床结局相关。
在这项回顾性观察研究中，分析了一家三级医院956例AHF出院患者的数据。在首次入院时（访视1）以及出院后中位数为26（15 - 39）天（访视2）时评估CA125水平。主要终点是CA125的变化及其与6个月死亡和再次入院（任何原因或与AHF相关）风险的相关性。采用多变量混合回归和双方程计数模型回归进行分析。
该队列的平均年龄为73.1±11.1岁，54.8%为男性，43.5%的左心室射血分数≥50%，18.7%的患者在出院时接受了达格列净治疗。与未使用达格列净的患者（-14 U/mL，p = 0.034）相比，达格列净治疗在随访时CA125水平降低幅度更大（-24 U/mL）。CA125降低幅度（每降低10 U/mL）与6个月死亡风险较低（发病率比[IRR]=0.98，95%可信区间[CI]=0.96 - 0.99；p = 0.049）、全因再次入院风险较低（IRR = 0.99，95%CI = 0.98 - 0.99；p = 0.003）以及心力衰竭再次入院风险较低（IRR = 0.98，95%CI = 0.97 - 0.99；p < 0.001）显著相关。
AHF发作后出院时使用达格列净治疗与出院后最初几周内CA125的更大幅度降低相关。CA125降低幅度更大表明患者6个月不良临床结局风险较低。
