Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure

      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.
      • LOS 7 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

      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)
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