Pre-hospital Aspirin Use and Patient Outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)

• Amos Lal ^[1] ; Juan Pablo Domecq Garces ^[1] ; Vikas Bansal ^[1] ; Aysun Tekin ^[1] ; Simon Zec ^[1] ; Ashish K. Khanna ^[2] ; Matthew A. Warner ^[1] ; Amy B. Christie ^[6] ; Rodrigo Cartin-Ceba ^[1] ; Valerie M. Banner-Goodspeed ^[3] ; Donna Lee Armaignac ^[7] ; Sreekanth R. Cheruku ^[8] ; Umamaheswara Raju ^[9] ; Yasir Tarabichi ^[4] ; Joshua L. Denson ^[10] ; Vishakha Kumar ^[11] ; Allan Walkey ^[5] ; Karen Boman ^[11] ; Neha Deo ^[1] ; Rahul Kashyap ^[1] ; Ognjen Gajic ^[1]
  1. [1] Mayo Clinic

     Mayo Clinic

     City of Rochester, Estados Unidos

     
  2. [2] Wake Forest University

     Wake Forest University

     Township of Winston, Estados Unidos

     
  3. [3] Beth Israel Deaconess Medical Center

     Beth Israel Deaconess Medical Center

     City of Boston, Estados Unidos

     
  4. [4] MetroHealth Medical Center

     MetroHealth Medical Center

     City of Cleveland, Estados Unidos

     
  5. [5] Boston University School of Medicine

     Boston University School of Medicine

     City of Boston, Estados Unidos

     
  6. [6] Atrium Health Navicent, Macon, GA, USA
  7. [7] Center for Advanced Analytics, Baptist Health South Florida, USA
  8. [8] Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, USA
  9. [9] Gandhi Medical College and Hospital, Hyderabad, India
  10. [10] Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, USA
  11. [11] Society of Critical Care Medicine, Mount Prospect, IL, USA

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 58, Nº. 11 (November), 2022, págs. 746-753
• Idioma: inglés
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• Resumen

  • Introduction The goal of this investigation is to assess the association between prehospital use of aspirin (ASA) and patient-centered outcomes in a large global cohort of hospitalized COVID-19 patients.

    Methods This study utilizes data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry. Adult patients hospitalized from February 15th, 2020, to September 30th, 2021, were included. Multivariable regression analyses were utilized to assess the association between pre-hospital use of ASA and the primary outcome of overall hospital mortality.

    Results 21,579 patients were included from 185 hospitals (predominantly US-based, 71.3%), with 4691 (21.7%) receiving pre-hospital ASA. Patients receiving ASA, compared to those without pre-admission ASA use, were generally older (median 70 vs. 59 years), more likely to be male (58.7 vs. 56.0%), caucasian (57.4 vs. 51.6%), and more commonly had higher rates of medical comorbidities. In multivariable analyses, patients receiving pre-hospital ASA had lower mortality (HR: 0.89, 95% CI 0.82–0.97, p=0.01) and reduced hazard for progression to severe disease or death (HR: 0.91, 95% CI 0.84–0.99, p=0.02) and more hospital free days (1.00 days, 95% CI 0.66–1.35, p=0.01) compared to those without pre-hospital ASA use. The overall direction and significance of the results remained the same in sensitivity analysis, after adjusting the multivariable model for time since pandemic.

    Conclusions In this large international cohort, pre-hospital use of ASA was associated with a lower hazard for death in hospitalized patients with COVID-19. Randomized controlled trials may be warranted to assess the utility of pre-hospital use of ASA.