Colluoglu Tugce, Kapansahin Tugba, Akın Yesim
Karabük University, Faculty of Medicine, Department of Cardiology, Karabük, 78200, Türkiye.
Karabük University, Faculty of Medicine, Department of Cardiology, Karabük, 78200, Türkiye.
Heart Lung. 2025 Jul 2;74:90-95. doi: 10.1016/j.hrtlng.2025.06.012.
Elevated circulating cancer antigen-125 (Ca-125) in heart failure has been proposed as a congestive and prognostic biomarker for patients with acute decompensated heart failure (ADHF). However, the relationship between circulating Ca-125 and diuretic efficiency in this population remains unknown.
We hypothesized that hospitalized ADHF patients with increased circulating Ca-125 levels are prone to high risk for the development of insufficient diuretic response.
We conducted the Receiver operator characteristics (ROC) analysis and binary logistic regression analysis to reveal the association between circulating Ca-125 level and diuretic response in hospitalized patients with ADHF. Insufficient diuretic response was defined as (1) a spot urinary Na+ <50 mEq/L in the spot urine sample collected 2 h following loop diuretic administration, and (2) <100 mL/hour diuresis after loop diuretic administration.
In the prospective observational cohort study, we enrolled 168 hospitalized patients with ADHF. Insufficient diuretic response and worsening renal function occurred in 45 (26.8 %) and 83 (49.4 %) patients, respectively. ROC analysis revealed that the optimal cut off of Ca-125 was 97.6 U/mL with a sensitivity of 64 %, and a specificity of 78 %. Overall model quality was 0.60. Using the binary logistic regression model, Ca-125≥97.6 U/mL (OR: 6.238, 95 %CI:2.712-14.349) and creatinine (OR: 4.194, 95 %CI:1.162-15.131) were independent predictors for the development of insufficient diuretic response.
In hospitalized patients with ADHF, Ca-125 ≥ 97.6 U/mL can be an effective sign in forecasting diuretic efficiency and may contribute to a better risk stratification for the development of insufficient diuretic response.
心力衰竭患者循环癌抗原125（Ca-125）升高被认为是急性失代偿性心力衰竭（ADHF）患者的充血和预后生物标志物。然而，该人群中循环Ca-125与利尿效率之间的关系尚不清楚。
我们假设循环Ca-125水平升高的住院ADHF患者发生利尿反应不足的风险较高。
我们进行了受试者操作特征（ROC）分析和二元逻辑回归分析，以揭示住院ADHF患者循环Ca-125水平与利尿反应之间的关联。利尿反应不足的定义为：（1）在给予襻利尿剂2小时后采集的即时尿样中，即时尿钠<50 mEq/L；（2）给予襻利尿剂后尿量<100 mL/小时。
在前瞻性观察队列研究中，我们纳入了168例住院ADHF患者。分别有45例（26.8%）和83例（49.4%）患者出现利尿反应不足和肾功能恶化。ROC分析显示，Ca-125的最佳截断值为97.6 U/mL，敏感性为64%，特异性为78%。总体模型质量为0.60%。使用二元逻辑回归模型，Ca-125≥97.6 U/mL（OR：6.238，95%CI：2.712 - 14.349）和肌酐（OR：4.194，95%CI：1.162 - 15.131）是利尿反应不足发生的独立预测因素。
在住院ADHF患者中，Ca-125≥97.6 U/mL可作为预测利尿效率的有效指标，可能有助于更好地对利尿反应不足的发生进行风险分层。
