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Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis
  1. Ka Hou Christien Li1,2,3,
  2. Mengqi Gong4,
  3. Guangping Li4,
  4. Adrian Baranchuk5,
  5. Tong Liu4,
  6. Martin C S Wong6,
  7. Aaron Jesuthasan3,
  8. Rachel W C Lai1,2,
  9. Jenny Chi Ling Lai1,2,
  10. Alex Pui Wai Lee1,2,
  11. Antoni Bayés-Genis7,8,
  12. Rafael de la Espriella9,10,11,
  13. Juan Sanchis9,10,11,
  14. William K K Wu2,12,13,
  15. Gary Tse1,2,13,
  16. Julio Nuñez9,10,
  17. On behalf of International Health Informatics Study (IHIS) Network
  1. 1 Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
  2. 2 Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
  3. 3 Faculty of Medicine, Newcastle University, England, UK
  4. 4 Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, china
  5. 5 Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
  6. 6 JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
  7. 7 Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  8. 8 Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
  9. 9 Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
  10. 10 Departamento de Medicina, Universitat de València, Valencia, Spain
  11. 11 CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
  12. 12 Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
  13. 13 Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
  1. Correspondence to Dr Gary Tse, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; tseg{at}cuhk.edu.hk; Professor William K K Wu, Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; wukakei{at}cuhk.edu.hk; Dr Julio Nuñez , Cardiology Department, Hospital Clínico Universitario de Valencia INCLIVA, Valencia, Spain; yulnunez{at}gmail.com

Abstract

Background Carbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF).

Methods PubMed and EMBASE databases were searched until 11 May 2018 for studies that evaluated the prognostic value of CA125 in AHF.

Results A total of 129 and 179 entries were retrieved from PubMed and EMBASE. Sixteen studies (15 cohort studies, 1 randomised trial) including 8401 subjects with AHF (mean age 71 years old, 52% male, mean follow-up 13 months, range of patients 525.1±598.2) were included. High CA125 levels were associated with a 68% increase in all-cause mortality (8 studies, HRs: 1.68, 95% CI 1.36 to 2.07; p<0.0001; I2: 74%) and 77% increase in heart failure-related readmissions (5 studies, HRs: 1.77, 95% CI 1.22 to 2.59; p<0.01; I2: 73%). CA125 levels were higher in patients with fluid overload symptoms and signs compared with those without them, with a mean difference of 54.8 U/mL (5 studies, SE: 13.2 U/mL; p<0.0001; I2: 78%).

Conclusion Our meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.

  • heart failure
  • heart failure treatment
  • systolic heart failure

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Footnotes

  • KHCL and MG are joint first authors.

  • Presented at The findings of this manuscript were presented at the Inaugural Clinical and Translational Cardiology Conference held in Hong Kong. The abstract will be published by the Journal of Geriatric Cardiology .

  • Contributors GT: study conception, study screening, data extraction, data analysis, data interpretation, statistical analysis, manuscript drafting, critical revision of the manuscript. MG: study screening, quality analysis, data extraction, manuscript drafting, critical revision of the manuscript. KHCL: study screening, data extraction, data analysis, data interpretation, statistical analysis, critical revision of the manuscript. RWCL, JCLL, GL, AB, TL, MCSW, APWL, ABG, RdlE, JS and AJ: data interpretation, manuscript redrafting, critical revision of the manuscript. WKKW and JN: study conception, study supervision, data interpretation, data interpretation, manuscript redrafting, critical revision of the manuscript.

  • Funding This work was supported by grants from Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (16/11/00420, 16/11/00403), Fondo Europeo de Desarrollo Regional and Proyecto Integrado de Excelencia (PIE15/00013). GT is supported by a Clinical Assistant Professorship from the Croucher Foundation of Hong Kong.

  • Competing interests JN reports personal fees from Novartis, personal fees from Vifor, personal fees from Abbott, personal fees from Rovi, personal fees from Boehringer Ingelheim and personal fees from Novo Nordisk, outside the submitted work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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