Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data Meta-Analysis Using Propensity Matching*

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>The primary objective was to conduct a meta-analysis on published observational cohort data describing the association between acetyl-salicylic acid (aspirin) use prior to the onset of sepsis and mortality in hospitalized patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Study Selection:</jats:title> <jats:p>Studies that reported mortality in patients on aspirin with sepsis with a comparison group of patients with sepsis not on prior aspirin therapy were included.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Sources:</jats:title> <jats:p>Fifteen studies described hospital-based cohorts (<jats:italic toggle="yes">n</jats:italic> = 17,065), whereas one was a large insurance-based database (<jats:italic toggle="yes">n</jats:italic> = 683,421). Individual-level patient data were incorporated from all selected studies.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Extraction:</jats:title> <jats:p>Propensity analyses with 1:1 propensity score matching at the study level were performed, using the most consistently available covariates judged to be associated with aspirin. Meta-analyses were performed to estimate the pooled average treatment effect of aspirin on sepsis-related mortality.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Synthesis:</jats:title> <jats:p>Use of aspirin was associated with a 7% (95% CI, 2–12%; <jats:italic toggle="yes">p</jats:italic> = 0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (<jats:italic toggle="yes">I</jats:italic> <jats:sup>2</jats:sup> = 61.6%).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>These results are consistent with effects ranging from a 2% to 12% reduction in mortality risk in patients taking aspirin prior to sepsis onset. This association anticipates results of definitive studies of the use of low-dose aspirin as a strategy for reduction of deaths in patients with sepsis.</jats:p> </jats:sec>