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. 2023 Jul 25:14:1186384.
doi: 10.3389/fphar.2023.1186384. eCollection 2023.

Aspirin reduces the mortality risk of sepsis-associated acute kidney injury: an observational study using the MIMIC IV database

Sining Chen  1 , Shishi Li  1 , Chaoying Kuang  1 , Yuzhen Zhong  1 , Zhiqian Yang  1 , Yan Yang  1 , Fanna Liu  1
Affiliations

Aspirin reduces the mortality risk of sepsis-associated acute kidney injury: an observational study using the MIMIC IV database

Sining Chen et al. Front Pharmacol. .

Abstract

Introduction: Sepsis-associated acute kidney injury (SA-AKI) is a complication of sepsis and is characterized by high mortality. Aspirin affects cyclooxygenases which play a significant role in inflammation, hemostasis, and immunological regulation. Sepsis is an uncontrolled inflammatory and procoagulant response to a pathogen, but aspirin can inhibit platelet function to attenuate the inflammatory response, thus improving outcomes. Several studies have generated contradictory evidence regarding the effect of aspirin on patients with sepsis-associated acute kidney injury (SA-AKI). We conducted an analysis of the MIMIC IV database to investigate the correlation between aspirin utilization and the outcomes of patients with SA-AKI, as well as to determine the most effective dosage for aspirin therapy. Materials and methods: SA-AKI patients' clinical data were extracted from MIMIC-IV2.1. Propensity score matching was applied to balance the baseline characteristics between the aspirin group and the non-user group. Subsequently, the relationship between aspirin and patient death was analyzed by Kaplan-Meier method and Cox proportional hazard regression models. Results: 12,091 patients with SA-AKI were extracted from the MIMIC IV database. In the propensity score-matched sample of 7,694 individuals, lower 90-day mortality risks were observed in the aspirin group compared to the non-users group (adjusted HR: 0.722; 95%CI: 0.666, 0.783) by multivariable cox proportional hazards analysis. In addition, the Kaplan-Meier survival curves indicated a superior 90-day survival rate for aspirin users compared to non-users (the log-rank test p-value was 0.001). And the median survival time of patients receiving aspirin treatment was significantly longer than those not receiving (46.47 days vs. 24.26 days). In the aspirin group, the average ICU stay length was shorter than non-users group. (5.19 days vs. 5.58 days, p = 0.006). There was no significant association between aspirin and an increased risk of gastrointestinal hemorrhage (p = 0.144). Conclusion: Aspirin might reduce the average ICU stay duration and the 30-day or 90-day mortality risks of SA-AKI patients. No statistically significant difference in the risk of gastrointestinal hemorrhage was found between the aspirin group and the control group.

Keywords: aspirin; critically ill; mimic iv; mortality; sepsis; sepsis-associated acute kidney injury.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE1
FIGURE1
Flow diagram of the research.
FIGURE 2
FIGURE 2
Kaplan-Meier survival curves between two groups indicated the 30-day mortality risk for the SA-AKI patients. Non-aspirin users are represented by blue lines and aspirin users are represented by green lines.
FIGURE 3
FIGURE 3
Kaplan-Meier survival curves between two groups indicated the 90-day mortality risk for the SA-AKI patients. Non-aspirin users are represented by blue lines and aspirin users are represented by green lines.
FIGURE 4
FIGURE 4
Subgroup analysis of the relationship between aspirin and 90-Day mortality, illustrated by a Forest Plot.
FIGURE 5
FIGURE 5
Cox proportional-hazards model of the dose of aspirin and 90-day mortality in SA-AKI patients. Low-dose (300 mg/d) aspirin group is represented by blue lines and high-dose (>300 mg/d) aspirin group is represented by green lines.
See this image and copyright information in PMC

References

    1. Akinosoglou K., Alexopoulos D. (2014). Use of antiplatelet agents in sepsis: A glimpse into the future. Thrombosis Res. 133 (2), 131–138. 10.1016/j.thromres.2013.07.002 - DOI - PubMed
    1. Al Harbi S. A., Tamim H. M., Al-Dorzi H. M., Sadat M., Arabi Y. M. (2016). Association between aspirin therapy and the outcome in critically ill patients: A nested cohort study. BMC Pharmacol. Toxicol. 17, 5. 10.1186/s40360-016-0047-z - DOI - PMC - PubMed
    1. Burrell J. H., Yong J. L., Macdonald G. J. (1991). Analgesic nephropathy in fischer 344 rats: Comparative effects of chronic treatment with either aspirin or paracetamol. Pathology 23 (2), 107–114. 10.3109/00313029109060807 - DOI - PubMed
    1. Chen J., Shetty S., Zhang P., Gao R., Hu Y., Wang S., et al. (2014). Aspirin-triggered resolvin D1 down-regulates inflammatory responses and protects against endotoxin-induced acute kidney injury. Toxicol. Appl. Pharmacol. 277 (2), 118–123. 10.1016/j.taap.2014.03.017 - DOI - PMC - PubMed
    1. Cox D., Maree A. O., Dooley M., Conroy R., Byrne M. F., Fitzgerald D. J. (2006). Effect of enteric coating on antiplatelet activity of low-dose aspirin in healthy volunteers. Stroke 37 (8), 2153–2158. 10.1161/01.STR.0000231683.43347.ec - DOI - PubMed