Admission C-reactive protein and outcomes in acute aortic dissection: a systematic review

AIM: To assess the prognostic role of admission C-reactive protein (CRP) in patients with acute aortic dissection (AAD). METHODS: We searched Medline and Scopus for studies published before January 2019 that evaluated the prognostic impact of CRP on all-cause mortality during short- and mid-term follow-up period in patients with AAD. Additional studies were identified by manual search of the references from the original studies. Receiver-operating characteristic curves were used to determine the optimal cut-off values of admission CRP for the prediction of mortality, and patients were categorized into two groups based on the CRP cut-off levels. RESULTS: Medline, Scopus, and manual literature search yielded 138 citations. Based on the title and abstract analysis and review of potentially relevant studies, five studies, involving 711 patients, were included in the final analysis. Multivariate statistical analysis was performed in all the studies. The median admission CRP value across the studies was 13 mg/L (range 4-21 mg/L). Two out of three studies that evaluated in-hospital outcome and all of the studies that evaluated medium-term outcome reported a significant association between elevated CRP values and mortality. The studies that included treatment strategy (surgery vs conservative treatment) as a confounding variable confirmed a significant effect of elevated CRP values on both in-hospital and mid-term unfavorable outcomes. CONCLUSION: This systematic review demonstrated a clear association between elevated admission serum CRP levels and increased in-hospital and mid-term mortality risk in AAD.