Association between use of aspirin use before hospital admission and sepsis outcomes: a population-based cohort study

ObjectivesAntiplatelet agents have been shown to reduce serum levels of inflammatory markers and may reduce sepsis mortality. A previous randomized clinical trial did not find that aspirin use after hospitalization, compared with placebo, improve acute respiratory distress syndrome within 7 days. We aimed to examine the association between preadmission use of aspirin and sepsis outcome. MethodsWe conducted a population-based cohort study based on the National Health Insurance Research Database of Taiwan. The association between aspirin use and 90-day mortality in sepsis patients was determined by Cox proportional hazard models, adjusting for either individual covariates or a propensity score. Restricted mean survival time (RMST) analysis was performed as a sensitivity analysis. ResultsOf 52,982 patients with sepsis, 12,776 received preadmission use of aspirin, while 39,081 did not receive any antiplatelets. Use of aspirin before sepsis admission was associated with a decreased risk of 90-day mortality (PS-adjusted HR: 0.89, 95% CI: 0.84-0.93). RMST analysis confirmed the beneficial effect of aspirin which was associated with a 2% increase in survival time (RMST ratio 1.02, 95% CI: 1.01-1.03), when compared to nonuse. On PS adjusted analysis, the odds ratios (OR) of respiratory failure with the preadmission use of aspirin was 0.98 (95% CI: 0.93-1.03), but we did not find any significant association between prior aspirin use and respiratory failure. ConclusionsOur study confirms that prehospital aspirin use was associated with a reduced 90-day mortality rate among sepsis patients, but we did not find any substantial association with respiratory or acute renal failure.