【罂粟摘要】阿司匹林的使用与2019冠状病毒病住院患者的机械通气、重症监护病房入院率和住院死亡率降低有关
阿司匹林的使用与2019冠状病毒病住院患者的机械通气、重症监护病房入院率和住院死亡率降低有关
贵州医科大学 高鸿教授课题组
翻译：任文鑫 编辑：佟睿 审校：曹莹
冠状病毒病-2019年(新冠肺炎)与危重患者的高凝状态和增加患者的血栓形成风险有关。据我们所知，目前没有研究评估阿司匹林的使用是否与降低机械通气风险、重症监护病房(Icu)入院和住院死亡率有关。
对2020年3月至2020年7月间在美国多家医院接受新冠肺炎治疗的成人患者进行回顾性观察性队列研究。主要观察指标是需要机械通气。次要观察指标为ICU入院和住院死亡率。在调整了人口统计学和合并症的影响后，使用Cox比例风险模型计算了研究结果的调整风险比(HRs)。
412例患者纳入研究。314名患者(76.3%)没有服用阿司匹林，而98名患者(23.7%)在入院后24小时内或入院前7天内接受了阿司匹林治疗。阿司匹林的使用与较少的机械通气(35.7%的阿司匹林与48.4%的非阿司匹林，P=8.03)和ICU住院(38.8%的阿司匹林与51.0%的非阿司匹林，P=8.04)有关，但与住院死亡率没有明显联系(26.5%的阿司匹林与23.2%的非阿司匹林，P=8.51)。在调整了8个混杂变量后，阿司匹林的使用与机械通气风险(调整后HR，0.56，95%可信区间[CI]，0.37-0.85，P=0.007)、ICU住院(调整后HR，0.57，95%CI，0.38-0.85，P=0.005)和住院死亡率(调整后HR，0.53，95%CI，0.31-0.90，P=0.02)独立相关。两组在大出血方面无差异(P=0.05)。69)或阿司匹林使用者与非阿司匹林使用者之间明显的血栓形成(P=5.82)。调整8个混杂变量后，阿司匹林的使用与机械通气风险降低（校正HR，0.56，95%可信区间[CI]，0.37-0.85，P = 0.007），ICU入院（校正HR，0.57，95%CI，0.38-0.85，P = 0.005），住院死亡率（校正HR，0.53，95%CI，0.31-0.90，P = 0.02)独立相关.出血发生率或明显血栓形成在阿司匹林使用者和非阿司匹林使用者之间无显著性差异（P = 0.69）（P = 0.82）。
使用阿司匹林可能改善住院COVID-19患者的结局。但是，需要开展具有充分把握度的随机对照试验来评估在COVID-19患者中阿司匹林的使用与肺损伤和死亡率降低之间是否存在因果关系。
Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019
Abstract
BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.
METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.
RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but nocrude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation
(adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted
HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users.
CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.
翻译：任文鑫
编辑：佟睿
审校：曹莹