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Multicenter Study
. 2019 Sep 5;9(9):e029885.
doi: 10.1136/bmjopen-2019-029885.

N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study

Changjun Luo  1 , Jianwei Zhou  2 , Si Xiong  1 , Zhongqiang Kang  1 , Jing Zhang  1 , Yifan Sun  1 , Biyun Qin  1 , Kuaifa Fang  3
Affiliations
Multicenter Study

N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study

Changjun Luo et al. BMJ Open. .

Abstract

Objectives: N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is an unfavourable factor responsible for poor outcomes in the cardiovascular diseases. Nevertheless, the prognostic role of NT-pro-BNP in type B aortic dissection (TBAD) remains unclear. The aim of the current study was to investigate the relationship between NT-pro-BNP levels and in-hospital and long-term adverse prognosis in patients with TBAD.

Design: A retrospective multicentre study.

Setting: Liutie Central Hospital, Nanfang Hospital and Huiyang Hospital in China.

Participants: A total of 657 consecutive patients with TBAD were enrolled in the study. NT-pro-BNP was measured at admission and included patients were divided into three groups according to the tertiles of NT-pro-BNP (pg/mL): <95 (n=220), 95-312 (n=218) and >312 (n=219).

Primary and secondary outcome measures: Long-term mortality and in-hospital major adverse clinical events.

Results: Overall, in-hospital death occurred in 27 patients (4.1%), which was significantly higher in upper tertiles of NT-pro-BNP (0.5% vs 4.1% vs 7.8%, p<0.001). The incident of in-hospital major adverse clinical events increased along with higher NT-pro-BNP (1.4% vs 11.5% vs 15.5%, p<0.001). NT-pro-BNP >210 pg/mL had 81.5% sensitivity and 58.6% specificity for predicting in-hospital death (area under the curve= 0.774, 95% CI 0.692 to 0.855; p<0.001). After a median of 3.1 years of follow-up, 97 (14.8%) patients died. The Kaplan-Meier analysis indicated that the long-term cumulative mortality was higher in patients with NT-pro-BNP >210 pg/mL compared with patients with NT-pro-BNP ≤210 pg/mL (log-rank=26.92, p<0.001). In multivariable Cox survival modelling, NT-pro-BNP >210 pg/mL was independently associated with long-term death (adjusted HR 2.47, 95% CI 1.45 to 4.22, p=0.001).

Conclusions: NT-pro-BNP resulted as an independent predictor of adverse prognosis in patients with TBAD, thus could be used as a potential risk-stratification tool.

Keywords: Brain natriuretic peptide; aortic dissection; prognosis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Prevalence of in-hospital events. MACEs, major adverse clinical events.
Figure 2
Figure 2
ROC curves of NT-pro-BNP and D-dimer for predicting in-hospital mortality. NT-pro-BNP, N-terminal pro-B-type natriuretic peptide; ROC, receiver operating characteristic.
Figure 3
Figure 3
Cumulative mortality in the entire study cohort according to NT-pro-BNP cut-off. NT-pro-BNP, N-terminal pro-B-type natriuretic peptide.
See this image and copyright information in PMC

References

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