Prognostic impact of C-reactive protein in elderly patients with acute heart failure and preserved ejection fraction: the modulating role of carbohydrate antigen 125

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Aims The systemic inflammation in heart failure (HF) is a common process, even more evident in acute scenario. Elevated C-reactive protein (CRP) is typically linked to increased morbidity and mortality in both acute and chronic heart failure. Moreover, Carbohydrate Antigen 125 (CA125) is elevated in most of the AHF patients. In this cohort of elderly patients admitted for AHF and preserved ejection fraction, our objective was to evaluate the association between CRP values and long-term outcomes, stratified by plasma CA125 concentration. Methods and results This retrospective cohort study included 453 elderly patients hospitalized for acute heart failure with preserved ejection fraction. Patients were categorized into four groups based on CRP (>20 mg/dl) and CA125 (≥35 U/ml) levels. The primary endpoints were all-cause mortality and heart failure readmission. Median age was 87 years (IQR: 85–89), and 72.6% were women. During a median follow-up of 463 days, 358 patients (54.9%) died and 208 (45.9%) were rehospitalized. In multivariable Cox models, a significant interaction was observed between CRP and CA125 for mortality (p for interaction = 0.05). Patients with both elevated CRP and CA125 had the highest mortality risk (HR: 1.79, 95% CI: 1.27–2.10; p < 0.001), while CRP elevation alone was not associated with increased risk. A similar trend was observed for readmission (HR: 1.50, 95% CI: 1.07–2.11; p = 0.019), though the interaction did not reach significance (p = 0.080). Conclusion In patients with acute heart failure and preserved ejection fraction, the prognostic impact of CRP is influenced by CA125 levels. High CRP levels were associated with higher risk of death or heart failure hospitalization only when coexisted with high CA125. On the contrary, when CA125 was low, high CRP lacked prognostic effect.

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