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Impact of Aspirin Use on Outcomes in Patients With Hepatocellular Cancer: A Nationwide Analysis
Armaan Dhaliwal1,2, Aalam Sohal3,2, Kanwal Bains1
1Department of Internal Medicine, University of Arizona, South Campus, Tuscon, AZ, USA.
Insights
Long-term aspirin (ASA) use in hepatocellular carcinoma (HCC) patients was associated with significantly better in-hospital outcomes. This includes reduced risks of mortality, shock, and intensive care unit (ICU) admission, suggesting potential benefits of ASA in HCC management.
Area of Science:
- Oncology
- Gastroenterology
- Pharmacology
Background:
- Hepatocellular carcinoma (HCC) presents a significant challenge with poor survival rates, even with advanced immunotherapies.
- Aspirin (ASA) has shown potential in reducing HCC incidence through various molecular pathways.
- The impact of long-term ASA use on in-hospital outcomes for HCC patients remains understudied.
Purpose of the Study:
- To investigate the association between long-term aspirin use and in-hospital outcomes in patients diagnosed with hepatocellular carcinoma.
- To analyze the effects of aspirin on critical outcomes including sepsis, shock, acute kidney injury, ICU admission, and mortality.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016 to 2020 to identify HCC patients.
- Stratified patients into long-term ASA users and non-users, collecting data on demographics, comorbidities, interventions, and liver disease status.
- Employed multivariate analysis to assess the relationship between long-term ASA use and various in-hospital outcomes.
Main Results:
- The study included 224,735 HCC patients, with 8.4% on long-term ASA.
- Patients on long-term ASA demonstrated lower incidences of sepsis, shock, acute kidney injury, ICU admission, and in-hospital mortality.
- Multivariate analysis revealed that ASA use was linked to a 30% lower risk of in-hospital mortality, a 21% lower risk of shock, and a 31% lower risk of ICU admission.
Conclusions:
- Long-term aspirin use in HCC patients is associated with improved in-hospital outcomes, including reduced mortality, shock, and ICU admissions.
- These findings highlight the potential benefits of aspirin in managing HCC patients.
- Further randomized clinical trials are warranted to confirm these beneficial effects of aspirin on HCC patient outcomes.
Background:
Despite the use of new immunotherapies, hepatocellular carcinoma (HCC) has a poor survival rate. Through multiple molecular mechanisms, aspirin (ASA) has demonstrated a reduced incidence of HCC, however, the impact of long-term ASA use on in-hospital outcomes has not been studied.
Methods:
We queried the National Inpatient Sample (NIS) database from 2016 to 2020 to identify patients with HCC. Patients were stratified into two groups, based on long-term ASA use. Information was collected regarding patient demographics, Elixhauser comorbidities, interventions, etiology, and decompensations of liver disease. Outcomes studied included sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and in-hospital mortality. The association between long-term ASA use and outcomes was studied using multivariate analysis.
Results:
A total of 224,735 patients were included in the study. Of them, 18,835 (8.4%) patients were on long-term ASA. The majority of the patients with ASA use were White (61.3%), men (78.2%), and aged > 65 years old (68.8%). Patients in the ASA group had a higher incidence of non-alcoholic steatohepatitis (NASH) and decreased rates of hepatic decompensation than those not on ASA. Patients with ASA use had lower incidence of sepsis (2.76% vs. 3.54%), shock (4.86% vs. 8.23%), AKI (30.9% vs. 33.4%), ICU admission (3.88% vs. 7.4%) and in-hospital mortality (5.18% vs. 9.87%). After adjusting for confounding factors, ASA use was associated with a 30% lower risk of in-hospital mortality (adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.60 - 0.82, P < 0.001). ASA users also had 21% lower odds of developing shock (aOR: 0.79, 95% CI: 0.67 - 0.94, P = 0.007) and 31% lower odds of requiring ICU admission (aOR: 0.69, 95% CI: 0.54 - 0.78, P < 0.001).
Conclusions:
Our study noted that patients on long-term ASA use had better in-hospital outcomes such as mortality, shock, and ICU admissions compared to non-ASA users. These findings are of interest, and further randomized clinical trials confirming the benefits of ASA in improving outcomes in HCC patients need to be conducted.
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