Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data Meta-Analysis Using Propensity Matching*
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- James Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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- Stephen Muhi
- Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, Victoria, Australia.
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- Shmeylan A. Al Harbi
- Pharmaceutical Care Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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- Yaseen M. Arabi
- Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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- Andrew J. Boyle
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
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- Wei Chen
- Division of Pulmonary and Critical Medicine, Chiayi Christian Hospital, Chiayi, Taiwan.
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- Yung-Tai Chen
- Department of Nephrology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan, Republic of China.
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- Marco Falcone
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy.
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- Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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- Jack Godsell
- Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, Victoria, Australia.
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- Daryl Kor
- Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
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- Wolfgang Lösche
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
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- Daniel F. McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland.
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- Hollis R. O’Neal
- Louisiana State University Health Sciences Center, Department of Medicine, Section of Pulmonary and Critical Care Medicine, Baton Rouge, LA.
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- Michael Osthoff
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.
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- Gordon P. Otto
- Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
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- Maik Sossdorf
- Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
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- Min-Juei Tsai
- Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China.
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- Francesco Violi
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy.
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- Lorraine Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
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- Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.
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- Johannes Winning
- Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
Abstract
<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>
Journal
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- Critical Care Medicine
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Critical Care Medicine 45 (11), 1871-1879, 2017-11
Ovid Technologies (Wolters Kluwer Health)
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Details 詳細情報について
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- CRID
- 1361699993360359424
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- ISSN
- 00903493
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- Data Source
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- Crossref