N-terminal pro-brain natriuretic peptide and short-term mortality in acute aortic dissection: A meta-analysis

Background Acute aortic dissection (AAD) is a life-threatening medical emergency that requires immediate diagnosis and rapid treatment. There is a paucity of data on the role of biomarkers in risk stratification of patients with AAD. Hypothesis N-terminal pro-brain natriuretic peptide (NT-proBNP) is associated with short-term mortality in AAD patients. Methods We systematically searched Medline and Scopus to identify all observational cohort studies published before January 2020 that compared outcome (short-term mortality) in patients with AAD with high vs low levels of baseline NT-proBNP combining terms brain natriuretic peptide and aortic dissection. A meta-analysis was conducted using the generic inverse variance method. Heterogeneity between studies was investigated using the Cochrane's Q test andI(2)statistic. Results Four studies were included in final analysis including a total of 950 patients, and 105 (11%) patients died. Baseline NT-proBNP concentrations were significantly higher in nonsurvivors (median 2240 pg/mL, range 1678-16 347 pg/mL) when compared to survivors (665 pg/mL, 328-1252 pg/mL). Elevated NT-proBNP values were significantly associated with an increased risk of short-term mortality (odds ratio 4.13, 95% CI [confidence interval] 2.33-7.33), with low heterogeneity (I-2= 8.77%, Cochran Q = 2.19,P= .33), and no publication bias. The pooled standardized mean difference between groups was 1.28 (95% CI 0.99-1.56), with low heterogeneity (I-2= 38.73%, Cochran Q = 3.26,P= .19). Conclusion Elevated NT-proBNP levels on admission are associated with an increased risk of short-term mortality in AAD.