Trauer, James, Muhi, Stephen, McBryde, Emma S., Al Harbi, Shmeylan A., Arabi, Yaseen M., Boyle, Andrew J., Cartin-Ceba, Rodrigo, Chen, Wei, Chen, Yung-Tai, Falcone, Marco, Gajic, Ognjen, Godsell, Jack, Gong, Michelle Ng, Kor, Daryl, Lösche, Wolfgang, McAuley, Daniel F., O'Neal, Hollis R., Ostholff, Michael, Otto, Gordon P., Sossdorf, Maik, Tsai, Min-Juei, Valerio-Rojas, Juan C., van der Poll, Tom, Violi, Francesco, Ware, Lorraine, Widmer, Andreas F., Wiewel, Maryse A., Winning, Johannes, and Wisen, Damon P. (2017) Quantifying the effects of prior acetyl-salicylic acid on sepsis-related deaths: an individual patient data meta-analysis using propensity matching. Critical Care Medicine, 45 (11). pp. 1871-1879.

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Abstract

Objective: The primary objective was to conduct a meta-analysis on published observational cohort data describing the association between acetyl-salicylic acid (aspirin) use prior to the onset of sepsis and mortality in hospitalized patients.

Study Selection: Studies that reported mortality in patients on aspirin with sepsis with a comparison group of patients with sepsis not on prior aspirin therapy were included.

Data Sources: Fifteen studies described hospital-based cohorts (n = 17,065), whereas one was a large insurance-based database (n = 683,421). Individual-level patient data were incorporated from all selected studies.

Data Extraction: Propensity analyses with 1:1 propensity score matching at the study level were performed, using the most consistently available covariates judged to be associated with aspirin. Meta-analyses were performed to estimate the pooled average treatment effect of aspirin on sepsis-related mortality.

Data Synthesis: Use of aspirin was associated with a 7% (95% CI, 2–12%; p = 0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (I2 = 61.6%).

Conclusions: These results are consistent with effects ranging from a 2% to 12% reduction in mortality risk in patients taking aspirin prior to sepsis onset. This association anticipates results of definitive studies of the use of low-dose aspirin as a strategy for reduction of deaths in patients with sepsis.

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