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

4 years ago

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

Muhi, Stephen, Lösche, Wolfgang, Ware, Lorraine, O’Neal, Hollis R. Jr, Cartin-Ceba, Rodrigo, Chen, Wei, Trauer, James, McAuley, Daniel F., Violi, Francesco, McBryde, Emma S., Falcone, Marco, Chen, Yung-Tai, Sossdorf, Maik, Kor, Daryl, Godsell, Jack, van der Poll, Tom, Otto, Gordon P., Tsai, Min-Juei, Osthoff, Michael, Boyle, Andrew J., Winning, Johannes, Valerio-Rojas, Juan C., Wiewel, Maryse A., Widmer, Andreas F., Arabi, Yaseen M., Al Harbi, Shmeylan A., Eisen, Damon P., Gong, Michelle Ng, Gajic, Ognjen

Objective: Objective: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. Study Selection: Study Selection: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. Data Sources: Data Sources:Fifteen studies described hospital-based cohorts (n = 17,065), whereas one was a large insurance-based database (n = 683,421). Individual-level patient data were incorporated from all selected studies. Data Extraction: Data Extraction: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. Data Synthesis: Data Synthesis:Use of aspirin was associated with a 7% (95% CI, 2–12%; p = 0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (I2 = 61.6%). Conclusions: Conclusions: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.

Publisher URL: http://journals.lww.com/ccmjournal/Fulltext/2017/11000/Quantifying_the_Effects_of_Prior_Acetyl_Salicylic.10.aspx

DOI: 10.1097/CCM.0000000000002654