阿司匹林与脓毒症诱导的凝血病患者死亡率降低相关：一项回顾性队列研究。

Aspirin is associated with a reduction in mortality rate for patients with sepsis-induced coagulopathy: a retrospective cohort study.

作者信息

Xu Dan, Li Jingyuan, Wang Zhiyuan, Li Junda, Zhao Qingyu, Zhao Qiannan, Xie Fei, Li Tingting, Chen Jiying, Wang Xiya, Zhou Xin, Guo Yuan, Wei Shuxing

机构信息

Department of General Practice, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

The Key Laboratory of Cardiovascular Remodelling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.

出版信息

Front Pharmacol. 2025 Jul 28;16:1537994. doi: 10.3389/fphar.2025.1537994. eCollection 2025.

DOI:10.3389/fphar.2025.1537994

PMID:40792203

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12336037/

Abstract

BACKGROUND

This study aimed to examine whether aspirin reduces mortality in patients with sepsis-induced coagulopathy (SIC).

METHODS

In this retrospective cohort study, 1,194 patients with SIC were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was 28-day all-cause mortality. Secondary outcomes included 90-day and 1-year all-cause mortality, as well as length of stay in the intensive care unit (ICU). Missing data were handled using multiple imputation, and baseline differences between groups were adjusted through propensity score matching (PSM). The association between aspirin therapy and mortality in SIC patients was evaluated using both univariate and multivariate Cox proportional hazards models. Additionally, subgroup analyses were performed to investigate the effect of aspirin across different populations and to assess the impact of aspirin dosage on clinical outcomes. External validation was subsequently conducted to confirm the robustness of the findings.

RESULTS

After PSM, 280 aspirin-treated patients were matched with 280 non-aspirin patients. Aspirin use was associated with significantly lower 28-day mortality (11.8% vs. 29.3%, < 0.001), 90-day mortality (16.8% vs. 33.6%, < 0.001), and 1-year mortality (22.1% vs. 42.1%, < 0.001), as well as a shorter median ICU stay (2.19 vs. 3.14 days, < 0.001) among patients with SIC. Multivariate Cox regression further confirmed the protective effect of aspirin on 28-day (hazard ratio [HR]: 0.45, 95% confidence interval [CI]: 0.29-0.7), 90-day (HR: 0.55, 95% CI: 0.37-0.81), and 1-year mortality (HR: 0.59, 95% CI: 0.42-0.83). Additionally, when comparing the efficacy of low- high-dose aspirin therapy, the low-dose group demonstrated significantly lower 28-day, 90-day, and 1-year mortality rates. External validation further supported these findings, showing reduced 28-day mortality (15.3% vs. 35.9%, = 0.01) and improved overall survival ( = 0.0037) in the aspirin-treated group.

CONCLUSION

Aspirin use was associated with reduced 28-day, 90-day, and 1-year mortality, as well as a shorter ICU stay in patients with SIC. These findings were confirmed through external validation.

摘要

背景

本研究旨在探讨阿司匹林是否能降低脓毒症诱导的凝血病（SIC）患者的死亡率。

方法

在这项回顾性队列研究中，从重症监护医学信息数据库（MIMIC-IV）中识别出1194例SIC患者。主要结局是28天全因死亡率。次要结局包括90天和1年全因死亡率，以及重症监护病房（ICU）住院时间。使用多重填补法处理缺失数据，并通过倾向评分匹配（PSM）调整组间基线差异。使用单变量和多变量Cox比例风险模型评估阿司匹林治疗与SIC患者死亡率之间的关联。此外，进行亚组分析以研究阿司匹林在不同人群中的作用，并评估阿司匹林剂量对临床结局的影响。随后进行外部验证以确认研究结果的稳健性。

结果

经过PSM后，280例接受阿司匹林治疗的患者与280例未接受阿司匹林治疗的患者相匹配。使用阿司匹林与SIC患者28天死亡率显著降低相关（11.8%对29.3%，<0.001），90天死亡率（16.8%对33.6%，<0.001），1年死亡率（22.1%对42.1%，<0.001），以及ICU中位住院时间缩短（2.19天对3.14天，<0.001）。多变量Cox回归进一步证实了阿司匹林对28天（风险比[HR]：0.45，95%置信区间[CI]：0.29 - 0.7）、90天（HR：0.55，95% CI：0.37 - 0.81）和1年死亡率（HR：0.59，95% CI：0.42 - 0.83）的保护作用。此外，在比较低剂量和高剂量阿司匹林治疗的疗效时，低剂量组的28天、90天和1年死亡率显著更低。外部验证进一步支持了这些发现，显示阿司匹林治疗组的28天死亡率降低（15.3%对35.9%，=0.01）且总体生存率提高（=0.0037）。