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Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data
James Trauer1, Stephen Muhi, Emma S McBryde
11School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 2Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, Victoria, Australia. 3Australian Institute of Tropical Medicine and Hygiene, James Cook University, Douglas, Queensland, Australia. 4Pharmaceutical Care Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 5Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 6Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland. 7Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN. 8Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 9Division of Pulmonary and Critical Medicine, Chiayi Christian Hospital, Chiayi, Taiwan. 10Department of Nephrology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan, Republic of China. 11Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. 12Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY. 13Department of Medicine, Albert Einstein College of Medicine, Bronx, NY. 14Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. 15Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN. 16Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. 17Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland. 18Louisiana State University Health Sciences Center, Department of Medicine, Section of Pulmonary and Critical Care Medicine, Baton Rouge, LA. 19Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. 20Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany. 21Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China. 22Department of Internal Medicine, Division of Critical Care Medicine, San Rafael Hospital, Alajuela, Costa Rica. 23Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 24Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 25Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. 26Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. 27The Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 28College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. 29Infectious Diseases Unit, The Townsville Hospital, Douglas, Queensland, Australia.
Aspirin use before sepsis onset was linked to a 7% reduction in mortality risk. This meta-analysis suggests aspirin may lower death rates in hospitalized patients with sepsis.
Area of Science:
- Clinical Medicine
- Pharmacology
- Epidemiology
Background:
- Sepsis is a life-threatening condition with high mortality rates.
- Acetyl-salicylic acid (aspirin) is widely used for various indications.
- The role of pre-sepsis aspirin use in patient outcomes remains an area of investigation.
Purpose of the Study:
- To perform a meta-analysis of observational cohort studies.
- To investigate the association between pre-sepsis aspirin use and mortality in hospitalized patients.
- To quantify the risk reduction in sepsis-related mortality associated with aspirin.
Main Methods:
- Included published observational cohort studies reporting sepsis mortality in aspirin users versus non-users.
- Utilized individual-level patient data from 15 hospital-based cohorts (n=17,065) and one insurance database (n=683,421).
- Conducted propensity score matching and meta-analyses to estimate the treatment effect on mortality.
Main Results:
- Aspirin use was associated with a statistically significant 7% reduction in the risk of death (95% CI, 2-12%; p = 0.005).
- The meta-analysis exhibited considerable statistical heterogeneity (I² = 61.6%).
- The observed effect size suggests a mortality risk reduction between 2% and 12%.
Conclusions:
- Pre-sepsis aspirin use is associated with reduced mortality in hospitalized patients.
- These findings support further investigation into low-dose aspirin as a sepsis mortality reduction strategy.
- The results align with the potential benefits of aspirin in sepsis management.
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