Highlights
- •The optimal length of stay for acute heart failure (HF) hospitalization is uncertain.
- •Up to now, longer but also shorter stays are associated with an increased risk of HF readmission.
- •CA125 is a valuable biomarker for congestion, worse prognosis, and a valuable tool for guiding treatment in patients with HF.
- •Patients with CA125≥35 U/mL displayed higher rates of 6-month HF readmission.
- •LOS7 days shows a protective role in the risk of mid-term HF readmission in patients with high CA125 levels.
Abstract
Background
The optimal length of stay (LOS) in patients hospitalized for acute heart failure
(AHF) remains controversial. Plasma antigen carbohydrate 125 (CA125) has emerged as
a reliable proxy of congestion. We aimed to evaluate whether there is a differential
impact of LOS on the risk of 6-month AHF readmission across CA125 levels.
Methods
This is a retrospective study that included 1,387 patients discharged for AHF in two
third-level centers. CA125 was measured 48±24 h after admission. The association between
CA125 and LOS with the risk of subsequent AHF readmission at 6 months was analyzed
by Cox regression analysis accounting for death as a competing event.
Results
The median (IQR) age of the sample was 78 (69–83) years, 625 (41.1%) patients were
women, and 832 (60%) exhibited preserved left ventricular ejection fraction. The median
LOS and CA125 were 6 (4–9) days and 36 (17–83) U/mL, respectively. A total of 707
(51%) patients displayed high CA125 levels (≥35 U/mL). At 6 months, 87 deaths (6,3%)
and 304 AHF readmissions (21,9%) were registered, respectively. A multivariate analysis
revealed a differential effect of LOS on 6-month AHF readmission across CA125 levels
(p-value for interaction=0.010). In those with CA125<35 U/mL, LOS≥7 days did not modify
the risk (HR:1.31; 95% CI: 0.92-1.87, p=0.131). Conversely, in those with CA125≥35 U/mL, LOS≥7 days was associated with a
lower risk of AHF readmission (HR:0.70; 95% CI: 0.51-0.98, p=0.036).
Conclusions
In patients with AHF, high CA125 levels may identify those patients that benefit from
a more prolonged hospitalization in terms of reducing the risk of mid-term AHF readmissions.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AHF (acute heart failure), CA125 (antigen carbohydrate 125), CI (confidence interval), CRT (cardiac resynchronization therapy), ECG (electrocardiogram), HF (heart failure), HR (hazard ratios), ICD (implantable cardioverter-defibrillator), IQR (interquartile range), LOS (length of stay), LVEF (left ventricular ejection fraction), MUC16 (mucin 16), NT-proBNP (amino-terminal pro-brain natriuretic peptide), NYHA (New York Heart Association), SBP (systolic blood pressure)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 12, 2021
Accepted:
May 21,
2021
Received in revised form:
May 20,
2021
Received:
February 23,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
