Treatment with aspirin might reduce mortality risk in patients with sepsis-associated acute kidney injury (SA-AKI) admitted to the ICU, investigators report.
In a propensity score analysis of 7694 adults with SA-AKI, the risk of dying within 90 days was 27.8% lower among those who received aspirin compared with those who did not, Fanna Liu, MD, and colleagues from The First Affiliated Hospital of Jinan University, in Guangzhou, China, reported in the Frontiers of Pharmacology. The median survival time was significantly longer for patients treated with vs without aspirin: 46.47 vs 24.26 days.
Hypertension, diabetes, and prior cardiac surgery are common in this population and each factor increases cardiovascular-related mortality. Aspirin use was associated with greater benefits in these patients. Aspirin significantly reduced the risk for early mortality by 33.3% in patients with prior cardiac surgery patients compared with 19.7% in patients without cardiac surgery. Patients with hypertension and diabetes had 24.2% and 28.2% lower mortality risk with aspirin use, respectively. Patients without these conditions had 24.1% and 21.2% reduced risks for early mortality, respectively.
Aspirin might exert beneficial effects on the cardiovascular system, the investigators suggested. In sepsis-associated AKI, aspirin may exert anti-inflammatory and anti-platelet effects. By AKI stage, patients with stage 3 AKI had the greatest 90-day mortality risk reduction (32.6%).
Dr Lui’s team also found a dose-dependent response. High-dose aspirin of more than 300 mg/d was significantly associated with a 14.8% reduced risk for early mortality compared with lower-dose aspirin. Enteric-coated aspirin appeared less effective than plain aspirin. High-dose aspirin inhibits both cyclooxygenase 1 and 2, whereas lower dose aspirin inhibits only 1 form of the enzyme.
ICU length of stay was significantly shorter for the aspirin than non-aspirin group: 5.19 vs 5.58 days.
Gastrointestinal hemorrhage rates did not differ between patients taking vs not taking aspirin.
“Aspirin may be an effective drug for SA-AKI,” according to Dr Liu’s team.
Chen S, Li S, Kuang C, et al. Aspirin reduces the mortality risk of sepsis-associated acute kidney injury: an observational study using the MIMIC IV database. Front Pharmacol. Published online July 25, 2023. doi:10.3389/fphar.2023.1186384