Aspirin use is associated with the reduced mortality risk in chronic obstructive pulmonary disease with sepsis: a retrospective study using the MIMIC-IV database

Background: Sepsis has the characteristics of high morbidity and high mortality in intensive care unit (ICU) patients. Chronic obstructive pulmonary disease (COPD) is an important cause of death. Studies have shown the value of aspirin on COPD and sepsis, separately, but its role in the combined COPD and sepsis patients is unclear. This study aimed to analyze the association of aspirin use after ICU admission with the mortality risk in COPD patients with sepsis.

Methods: We conducted a retrospective study using the Medical Information Mart for Intensive Care (MIMIC)-IV database, enrolling 2,964 COPD patients with sepsis admitted to ICU. They were divided into aspirin users (n=1,642) and non-users (n=1,322). We evaluated the association of aspirin use with in-hospital and 28-day mortality using logistic regression, Kaplan-Meier survival analysis, and Cox proportional-hazards models. The role of aspirin dose and the association of aspirin use with 90-day and 1-year mortality were also assessed.

Results: Aspirin use was associated with lower in-hospital death (13.642% vs. 23.676%) and 28-day mortality (17.296% vs. 30.257%) (P<0.001). Adjusted models confirmed reduced mortality odds ratio (OR) with aspirin use: OR for in-hospital mortality was 0.574 [95% confidence interval (CI): 0.456, 0.721] and 28-day mortality was 0.539 (95% CI: 0.437, 0.665) in model 3. Survival analyses showed higher survival probabilities for aspirin users. Subgroup analyses supported consistent aspirin benefits across various clinical parameters. Additionally, aspirin users had lower 90-day (21.498% vs. 34.191%) and 1-year mortality (27.649% vs. 41.982%) (P<0.001).

Conclusions: Aspirin use is significantly related to in-hospital and 28-day mortality risk in COPD patients with sepsis. This highlighted the clinical relevance of aspirin in COPD patients with sepsis.