Association of aspirin use with mortality in critically ill patients with chronic obstructive pulmonary disease: A retrospective propensity score-matched cohort study.

Background: The impact of aspirin on mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear, particularly those who are critically ill.

Methods: This retrospective cohort study utilized data from the MIMIC-IV 3.1 database to investigate the correlation between aspirin use and 30-day mortality among critically ill adult patients diagnosed with COPD. Patients who initiated aspirin therapy within the first 24 h of intensive care unit (ICU) admission were included in the analysis. The primary outcome was 30-day mortality. Multivariable analysis, 1:1 propensity score matching, and standardized mortality ratio weighting (SMRW) were employed to adjust for confounding factors.

Results: A total of 3184 patients were included in the study. The 30-day mortality rate was 13.0 % in aspirin recipients (140/1074) compared to 22.6 % in non-recipients (476/2110). Analysis using SMRW demonstrated a significant association between aspirin use and reduced 30-day mortality (HR, 0.64; 95 % CI, 0.52-0.77; P < 0.001). Furthermore, aspirin use was associated with decreased in-hospital mortality (OR, 0.69; 95 % CI, 0.50-0.96; P = 0.029), a longer duration without ICU readmission within 28 days (β, 1.13; 95 % CI, 0.30-1.96; P = 0.008), and prolonged time without mechanical ventilation within 28 days (β, 1.27; 95 % CI, 0.41-2.14; P = 0.004). Sensitivity analyses on the complete dataset confirmed a significant association between aspirin use and reduced 30-day mortality, with a hazard ratio of 0.72 (95 % CI, 0.59-0.87; P = 0.001).

Conclusions: Aspirin was associated with reduced mortality in critically ill patients with COPD. These findings warrant further prospective studies to confirm the observed benefits of aspirin use in this population.