• Miguel Lorenzo, Patricia Palau, Pau Llàcer, Eloy Domínguez, Bruno Ventura, Gonzalo Núñez, Gema Miñana, Javier Solsona, Enrique Santas, Rafael De La Espriella, Vicent Bodí, Eduardo Núñez, Juan Sanchis, Antoni Bayés-Genís, and Julio Núñez.
• Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain.
• Eur. J. Intern. Med. 2021 Oct 1; 92: 94-99.

BackgroundThe 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.MethodsThis 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.ResultsThe 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).ConclusionsIn 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.Copyright © 2021. Published by Elsevier B.V.

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