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. 2024 Jun 11;24(1):575.
doi: 10.1186/s12879-024-09421-x.

Impact of P2Y12 inhibitors on clinical outcomes in sepsis-3 patients receiving aspirin: a propensity score matched analysis

Shaojun Jiang #  1   2 , Jianwen Xu #  1   2 , Chengjie Ke  1   2 , Pinfang Huang  3   4
Affiliations

Impact of P2Y12 inhibitors on clinical outcomes in sepsis-3 patients receiving aspirin: a propensity score matched analysis

Shaojun Jiang et al. BMC Infect Dis. .

Abstract

Background: Sepsis is a life-threatening disease accompanied by disorders of the coagulation and immune systems. P2Y12 inhibitors, widely used for arterial thrombosis prevention and treatment, possess recently discovered anti-inflammatory properties, raising potential for improved sepsis prognosis.

Method: We conducted a retrospective analysis using the data from Medical Information Mart for Intensive Care-IV database. Patients were divided into an aspirin-alone group versus a combination group based on the use of a P2Y12 inhibitor or not. Differences in 30-day mortality, length of stay (LOS) in intensive care unit (ICU), LOS in hospital, bleeding events and thrombotic events were compared between the two groups.

Result: A total of 1701 pairs of matched patients were obtained by propensity score matching. We found that no statistically significant difference in 30-day mortality in aspirin-alone group and combination group (15.3% vs. 13.7%, log-rank p = 0.154). In addition, patients received P2Y12 inhibitors had a higher incidence of gastrointestinal bleeding (0.5% vs. 1.6%, p = 0.004) and ischemic stroke (1.7% vs. 2.9%, p = 0.023), despite having a shorter LOS in hospital (11.1 vs. 10.3, days, p = 0.043). Cox regression showed that P2Y12 inhibitor was not associated with 30-day mortality (HR = 1.14, 95% CI 0.95-1.36, p = 0.154).

Conclusion: P2Y12 inhibitors did not provide a survival benefit for patients with sepsis 3 and even led to additional adverse clinical outcomes.

Keywords: Bleeding; Inflammation; P2Y12 inhibitors; Sepsis; Thrombosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient screening
Fig. 2
Fig. 2
Kaplan-Meier curves for 30-day mortality in matched data. Note: A, survival probability of patients in the aspirin-alone and combination groups over time. B, cumulative risk of 30-day mortality. C, the number of patients at risk at each time point
Fig. 3
Fig. 3
Forest plot of multivariate cox regression for 30-day mortality after propensity score matching. Note: SOFA: sequential organ failure assessment; COPD: chronic obstructive pulmonary disease; INR: international normalized ratio; PT, prothrombin time; HR, hazard ratio; CI, confidence interval
See this image and copyright information in PMC

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