Dhaliwal Armaan, Sohal Aalam, Bains Kanwal, Chaudhry Hunza, Singh Ishandeep, Kalra Eva, Arora Kirti, Dukovic Dino, Boiles Alejandro Recio
Department of Internal Medicine, University of Arizona, South Campus, Tuscon, AZ, USA.
These authors contributed equally to this work.
World J Oncol. 2023 Jun;14(3):195-204. doi: 10.14740/wjon1601. Epub 2023 Jun 11.
Despite the use of new immunotherapies, hepatocellular carcinoma (HCC) has a poor survival rate. Through multiple molecular mechanisms, aspirin (ASA) has demonstrated a reduced incidence of HCC, however, the impact of long-term ASA use on in-hospital outcomes has not been studied.
We queried the National Inpatient Sample (NIS) database from 2016 to 2020 to identify patients with HCC. Patients were stratified into two groups, based on long-term ASA use. Information was collected regarding patient demographics, Elixhauser comorbidities, interventions, etiology, and decompensations of liver disease. Outcomes studied included sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and in-hospital mortality. The association between long-term ASA use and outcomes was studied using multivariate analysis.
A total of 224,735 patients were included in the study. Of them, 18,835 (8.4%) patients were on long-term ASA. The majority of the patients with ASA use were White (61.3%), men (78.2%), and aged > 65 years old (68.8%). Patients in the ASA group had a higher incidence of non-alcoholic steatohepatitis (NASH) and decreased rates of hepatic decompensation than those not on ASA. Patients with ASA use had lower incidence of sepsis (2.76% vs. 3.54%), shock (4.86% vs. 8.23%), AKI (30.9% vs. 33.4%), ICU admission (3.88% vs. 7.4%) and in-hospital mortality (5.18% vs. 9.87%). After adjusting for confounding factors, ASA use was associated with a 30% lower risk of in-hospital mortality (adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.60 - 0.82, P < 0.001). ASA users also had 21% lower odds of developing shock (aOR: 0.79, 95% CI: 0.67 - 0.94, P = 0.007) and 31% lower odds of requiring ICU admission (aOR: 0.69, 95% CI: 0.54 - 0.78, P < 0.001).
Our study noted that patients on long-term ASA use had better in-hospital outcomes such as mortality, shock, and ICU admissions compared to non-ASA users. These findings are of interest, and further randomized clinical trials confirming the benefits of ASA in improving outcomes in HCC patients need to be conducted.
尽管使用了新的免疫疗法，但肝细胞癌（HCC）的生存率仍很低。阿司匹林（ASA）通过多种分子机制已证明可降低HCC的发病率，然而，长期使用ASA对住院结局的影响尚未得到研究。
我们查询了2016年至2020年的国家住院患者样本（NIS）数据库，以识别HCC患者。根据长期使用ASA情况，将患者分为两组。收集了有关患者人口统计学、埃利克斯豪泽合并症、干预措施、病因以及肝病失代偿情况的信息。研究的结局包括脓毒症、休克、急性肾损伤（AKI）、重症监护病房（ICU）入院以及住院死亡率。使用多变量分析研究长期使用ASA与结局之间的关联。
该研究共纳入224,735例患者。其中，18,835例（8.4%）患者长期使用ASA。使用ASA的患者大多数为白人（61.3%）、男性（78.2%）且年龄>65岁（68.8%）。与未使用ASA的患者相比，ASA组患者非酒精性脂肪性肝炎（NASH）的发病率更高，肝失代偿率更低。使用ASA的患者脓毒症（2.76%对3.54%）、休克（4.86%对8.23%）、AKI（30.9%对33.4%）、ICU入院（3.88%对7.4%）和住院死亡率（5.18%对9.87%）的发生率更低。在调整混杂因素后，使用ASA与住院死亡率风险降低30%相关（调整后的优势比（aOR）：0.70，95%置信区间（CI）：0.60 - 0.82，P<0.001）。ASA使用者发生休克的几率也降低了21%（aOR：0.79，95%CI：0.67 - 0.94，P = 0.007），需要ICU入院的几率降低了31%（aOR：0.69，95%CI：0.54 - 0.78，P<0.001）。
我们的研究指出，与未使用ASA的患者相比，长期使用ASA的患者在住院死亡率、休克和ICU入院等住院结局方面更好。这些发现很有意义，需要进一步开展随机临床试验来证实ASA在改善HCC患者结局方面的益处。
