Supplementary Material for: Association of cancer antigen 125 with long-term prognosis in light-chain cardiorenal amyloidosis

Background: Light-chain (AL) cardiorenal amyloidosis has been characterized as type 5 cardiorenal syndrome with fluid overload and poor prognosis. Cancer antigen 125 (CA125) has the potential for use in evaluating fluid load and prognosis for heart failure. However, less details for CA125 in AL cardiorenal amyloidosis have been reported. Methods: Sixty patients diagnosed with AL cardiorenal amyloidosis were enrolled in this retrospective study. Patients were divided into two groups according to the cutoff point of CA125 level (35 U/mL). Logistic regression was used to screen variables associated with CA125. Cox regression analyses was utilized to verify the prognostic potential of CA125. Results: The mean age was 61±8 years, and 68% of the participants were male. Compared to patients with normal CA125 levels (≤35 U/mL), patients with high levels of CA125 (>35 U/mL) had a higher proportion of New York Heart Association class >II, pericardial effusion, and edema, as well as a lower level of albumin and left ventricular longitudinal strain (LVLS). Logistic regression showed age, albumin, and LVLS to be independently associated with CA125. Seventeen (28%) patients died during the follow-up. Multivariate model including CA125, estimated glomerular filtration rate, E/e’ and left ventricular ejection fraction showed acceptable prognostic potential (C-index= 0.829, 95%CI 0.749 to 0.909). CA125 remained an independent prognostic factor (HR=1.018, 95%CI 1.005 to 1.031, P=0.008) after adjusting for the remaining three variates and provided a significant incremental effect to the risk determined from them (C-index 0.829 vs 0.784, P=0.037). Conclusions: Serum CA125 level was associated with long-term prognosis of AL cardiorenal amyloidosis.背景：轻链（AL）型心肾淀粉样变性被归类为5型心肾综合征，以液体负荷过重及预后不良为特征。癌抗原125（CA125）在评估心力衰竭患者的液体负荷与预后方面具有应用潜力，但目前针对AL型心肾淀粉样变性中CA125的相关研究报道仍较为匮乏。 方法：本回顾性研究共纳入60例经确诊的AL型心肾淀粉样变性患者。以CA125水平35 U/mL为截断值，将患者分为两组。采用Logistic回归筛选与CA125水平相关的变量，通过Cox回归分析验证CA125的预后价值。 结果：本研究纳入患者的平均年龄为61±8岁，其中男性占比68%。与CA125水平正常（≤35 U/mL）的患者相比，CA125水平升高（>35 U/mL）的患者纽约心脏协会心功能分级>II级、心包积液及水肿的占比更高，同时白蛋白水平与左心室纵向应变（LVLS）更低。Logistic回归分析显示，年龄、白蛋白水平及左心室纵向应变与CA125水平独立相关。随访期间共有17例（28%）患者死亡。包含CA125、估算肾小球滤过率、E/e’及左心室射血分数的多因素模型具有良好的预后预测价值（C指数=0.829，95%置信区间0.749~0.909）。在校正其余三项变量后，CA125仍为独立预后因素（风险比=1.018，95%置信区间1.005~1.031，P=0.008），且可为上述变量构建的风险预测模型带来显著的增量价值（C指数0.829 vs 0.784，P=0.037）。 结论：血清CA125水平与AL型心肾淀粉样变性的长期预后相关。