Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19.
Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19.
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DOI：
10.1001/jamanetworkopen.2022.3890
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发表时间：
2022-03-01
影响因子：
13.8
通讯作者：
N3C Consortium and ANCHOR Investigators
中科院分区：
文献类型：
--
作者：
Chow JH;Rahnavard A;Gomberg-Maitland M;Chatterjee R;Patodi P;Yamane DP;Levine AR;Davison D;Hawkins K;Jackson AM;Quintana MT;Lankford AS;Keneally RJ;Al-Mashat M;Fisher D;Williams J;Berger JS;Mazzeffi MA;Crandall KA;N3C Consortium and ANCHOR Investigators
这项队列研究调查了早期使用阿司匹林是否与中度COVID-19患者28天住院死亡率降低相关。中度COVID-19住院患者早期使用阿司匹林是否与住院死亡率降低相关？在一项对112269名中度COVID-19患者进行的队列研究中，与未早期服用阿司匹林的患者相比，住院第一天早期服用阿司匹林与28天住院死亡率和肺栓塞发生率降低相关。这项研究表明，早期使用阿司匹林可能与中度COVID-19住院患者的院内死亡率较低有关;这些发现值得在包括不同心血管合并症患者的随机临床试验中进一步研究。此前的观察性研究表明，阿司匹林的使用可能与高风险住院COVID-19患者的死亡率降低有关，但阿司匹林在中度COVID-19患者中的疗效尚未得到充分研究。评估早期使用阿司匹林是否与中度COVID-19患者的院内死亡率降低相关。对112269名中度COVID-19住院患者进行的观察性队列研究，这些患者于2020年1月1日至2021年9月10日在美国64个卫生系统参加了美国国立卫生研究院的国家COVID队列协作（N3 C）。住院第一天内使用阿司匹林。主要结局为28天住院死亡率，次要结局为肺栓塞和深静脉血栓形成。使用边际结构考克斯和逻辑回归模型计算住院死亡率的比值。使用治疗权重的逆概率来减少混杂偏倚，并平衡组间特征。在接受筛查的2 446 650名COVID-19阳性患者中，189 287人住院，112 269人符合研究入选标准。对于整个队列，中位年龄为63岁（IQR，47-74岁）; 16.1%的患者为非洲裔美国人，3.8%为亚洲人，52.7%为白色，5.0%为其他人种和种族，22.4%的人种和种族不详。10.9%的患者发生院内死亡。经过逆概率治疗加权后，接受阿司匹林治疗的患者28天住院死亡率显著降低（10.2% vs 11.8%;比值比[OR]，0.85; 95%CI，0.79-0.92; P <0.001）。接受阿司匹林治疗的患者的肺栓塞发生率（而非深静脉血栓形成）也显著较低（1.0% vs 1.4%; OR，0.71; 95% CI，0.56-0.90; P = 0.004）。早期服用阿司匹林的患者并没有更高的胃肠道出血发生率（0.8%阿司匹林vs 0.7%无阿司匹林; OR，1.04; 95% CI，0.82-1.33; P = 0.72），脑出血（0.6%阿司匹林vs 0.4%无阿司匹林; OR，1.32; 95% CI，0.92-1.88; P = .13）或输血（2.7%阿司匹林vs 2.3%无阿司匹林; OR，1.14; 95% CI，0.99-1.32; P = .06）。出血并发症的复合发生率在接受阿司匹林的患者中并不高（3.7%阿司匹林vs 3.2%无阿司匹林; OR，1.13; 95% CI，1.00-1.28; P = 0.054）。受益最多的亚组包括60岁以上的患者（61-80岁：OR，0.79; 95% CI，0.72-0.87; P < .001; >80岁：OR，0.79; 95% CI，0.69-0.91; P < .001）和合并症患者（1例合并症：6.4% vs 9.2%; OR，0.68; 95% CI，0.55-0.83; P <0.001; 2例合并症：10.5% vs 12.8%; OR，0.80; 95% CI，0.69-0.93; P = 0.003; 3例合并症：13.8% vs 17.0%，OR，0.78; 95%CI，0.68-0.89; P < .001; >3种合并症：17.0% vs 21.6%; OR，0.74; 95%CI，0.66-0.84; P < .001）。在这项针对因中度COVID-19住院的美国成年人的队列研究中，早期使用阿司匹林与28天住院死亡率较低相关。一项包括不同中度COVID-19患者的随机临床试验有必要充分评估阿司匹林对高危患者的疗效。
This cohort study investigates whether early aspirin use is associated with lower 28-day in-hospital mortality among patients with moderate COVID-19. Is early aspirin use in hospitalized patients with moderate COVID-19 associated with lower odds of in-hospital mortality? In a cohort study of 112 269 patients with moderate COVID-19, early aspirin use during the first day of hospitalization was associated with lower 28-day in-hospital mortality and pulmonary embolism incidence when compared with patients who did not receive early aspirin. This study suggests that early aspirin use may be associated with lower odds of in-hospital mortality among hospitalized patients with moderate COVID-19; these findings warrant further study in a randomized clinical trial that includes diverse patients with cardiovascular comorbidities. Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin’s efficacy in patients with moderate COVID-19 is not well studied. To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health’s National COVID Cohort Collaborative (N3C). Aspirin use within the first day of hospitalization. The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups. Among the 2 446 650 COVID-19–positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P < .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P < .001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < .001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < .001). In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin’s efficacy in patients with high-risk conditions.
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DOI：
10.1056/nejmoa1805819
发表时间：
2018-10-18
期刊：
The New England journal of medicine
影响因子：
--
作者：
McNeil JJ;Wolfe R;Woods RL;Tonkin AM;Donnan GA;Nelson MR;Reid CM;Lockery JE;Kirpach B;Storey E;Shah RC;Williamson JD;Margolis KL;Ernst ME;Abhayaratna WP;Stocks N;Fitzgerald SM;Orchard SG;Trevaks RE;Beilin LJ;Johnston CI;Ryan J;Radziszewska B;Jelinek M;Malik M;Eaton CB;Brauer D;Cloud G;Wood EM;Mahady SE;Satterfield S;Grimm R;Murray AM;ASPREE Investigator Group
通讯作者：
ASPREE Investigator Group
DOI：
10.1093/jamia/ocab217
发表时间：
2022-03-15
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Pfaff ER;Girvin AT;Gabriel DL;Kostka K;Morris M;Palchuk MB;Lehmann HP;Amor B;Bissell M;Bradwell KR;Gold S;Hong SS;Loomba J;Manna A;McMurry JA;Niehaus E;Qureshi N;Walden A;Zhang XT;Zhu RL;Moffitt RA;Haendel MA;Chute CG;N3C Consortium;Adams WG;Al-Shukri S;Anzalone A;Baghal A;Bennett TD;Bernstam EV;Bernstam EV;Bissell MM;Bush B;Campion TR;Castro V;Chang J;Chaudhari DD;Chen W;Chu S;Cimino JJ;Crandall KA;Crooks M;Davies SJD;DiPalazzo J;Dorr D;Eckrich D;Eltinge SE;Fort DG;Golovko G;Gupta S;Haendel MA;Hajagos JG;Hanauer DA;Harnett BM;Horswell R;Huang N;Johnson SG;Kahn M;Khanipov K;Kieler C;Luzuriaga KR;Maidlow S;Martinez A;Mathew J;McClay JC;McMahan G;Melancon B;Meystre S;Miele L;Morizono H;Pablo R;Patel L;Phuong J;Popham DJ;Pulgarin C;Santos C;Sarkar IN;Sazo N;Setoguchi S;Soby S;Surampalli S;Suver C;Vangala UMR;Visweswaran S;Oehsen JV;Walters KM;Wiley L;Williams DA;Zai A
通讯作者：
Zai A
影响因子：
5
作者：
Hernan, Miguel A.;Robins, James M.
通讯作者：
Robins, James M.
影响因子：
7.2
作者：
Hernan, Miguel A.;Sauer, Brian C.;Shrier, Ian
通讯作者：
Shrier, Ian
DOI：
10.1093/jamia/ocaa196
发表时间：
2021-03-01
影响因子：
6.4
作者：
Haendel, Melissa A.;Chute, Christopher G.;Gersing, Ken R.
通讯作者：
Gersing, Ken R.