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 and I (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.