Falcone Marco, Russo Alessandro, Cangemi Roberto, Farcomeni Alessio, Calvieri Camilla, Barillà Francesco, Scarpellini Maria Gabriella, Bertazzoni Giuliano, Palange Paolo, Taliani Gloria, Venditti Mario, Violi Francesco
Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (R.C., C.C., F.B., F.V.).
J Am Heart Assoc. 2015 Jan 6;4(1):e001595. doi: 10.1161/JAHA.114.001595.
Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia.
Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality.
This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia.
肺炎常并发高死亡率和心血管事件（CVE）。阿司匹林通过抑制血栓素A2生成降低血小板聚集，其潜在益处仍不明确。本研究旨在评估阿司匹林对肺炎患者死亡率的影响。
连续纳入意大利罗马翁贝托一世大学医院收治的社区获得性肺炎患者，并进行前瞻性随访直至出院或死亡。主要终点为入院后30天内死亡的发生情况；次要终点为院内非致死性心肌梗死和缺血性卒中的发生率。1005例患者（年龄74.7±15.1岁）纳入研究：390例患者住院时正在服用阿司匹林（100毫克/天），而615例患者未服用阿司匹林。随访期间，16.2%的患者死亡；其中，19例（4.9%）为阿司匹林使用者，144例（23.4%；P<0.001）为未使用阿司匹林者。总体而言，7%的患者发生非致死性CVE，未使用阿司匹林者为8.3%，使用阿司匹林者为4.9%（比值比1.77；95%置信区间1.03至3.04；P=0.040）。Cox回归分析显示，肺炎严重程度指数（PSI）、严重脓毒症、胸腔积液和动脉血氧分压/吸入氧分数比<300对生存有负面影响，而阿司匹林治疗与生存改善相关。与服用阿司匹林的患者相比，倾向评分调整分析证实未服用阿司匹林的患者总死亡率的风险比为2.07（1.08至3.98；P=0.029）。
本研究表明，在一大群肺炎患者中，长期使用阿司匹林与入院后30天内较低的死亡率相关。
