Aspirin is associated with a reduction in mortality rate for patients with sepsis-induced coagulopathy: A retrospective cohort study

Dan Xu¹Zhiyuan Wang¹Junda Li¹Qingyu Zhao¹Qiannan Zhao²Fei Xie¹Tingting Li¹Jiying Chen¹Xiya Wang³Xin Zhou^2*Yuan Guo^1*Shuxing Wei^3*

• ¹Qilu Hospital, Shandong University, Jinan, Shandong Province, China
• ²Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
• ³Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

This study aimed to examine whether aspirin reduces mortality in patients with sepsis-induced coagulopathy (SIC).In this retrospective cohort study, 1,194 patients with SIC were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was 28-day allcause mortality. Secondary outcomes included 90-day and 1-year all-cause mortality, as well as length of stay in the intensive care unit (ICU). Missing data were handled using multiple imputation, and baseline differences between groups were adjusted through propensity score matching (PSM). The association between aspirin therapy and mortality in SIC patients was evaluated using both univariate and multivariate Cox proportional hazards models. Additionally, subgroup analyses were performed to investigate the effect of aspirin across different populations and to assess the impact of aspirin dosage on clinical outcomes. External validation was subsequently conducted to confirm the robustness of the findings.After PSM, 280 aspirin-treated patients were matched with 280 non-aspirin patients. Aspirin use was associated with significantly lower 28-day mortality (11.8% vs. 29.3%, p < 0.001), 90-day mortality (16.8% vs. 33.6%, p < 0.001), and 1-year mortality (22.1% vs. 42.1%, p < 0.001), as well as a shorter median ICU stay (2.19 vs. 3.14 days, p < 0.001) among patients with SIC. Multivariate Cox regression further confirmed the protective effect of aspirin on 28-day (hazard ratio [HR]: 0.45, 95% confidence interval [CI]: 0.29-0.7), 90-day (HR: 0.55, 95% CI: 0.37-0.81), and 1-year mortality (HR: 0.59, 95% CI: 0.42-0.83). Additionally, when comparing the efficacy of low-versus high-dose aspirin therapy, the low-dose group demonstrated significantly lower 28-day, 90-day, and 1-year mortality rates. External validation further supported these findings, showing reduced 28-day mortality (15.3% vs. 35.9%, p = 0.01) and improved overall survival (p = 0.0037) in the aspirintreated group.Aspirin use was associated with reduced 28-day, 90-day, and 1-year mortality, as well as a shorter ICU stay in patients with SIC. These findings were confirmed through external validation.