Lower Mortality Rate in Elderly Patients With Community‐Onset Pneumonia on Treatment With Aspirin

Abstract

Background Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Methods and Results Consecutive patients admitted to the University‐Hospital Policlinico Umberto I (Rome, Italy) with community‐onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow‐up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P <0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P =0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO 2 /FiO 2 ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P =0.029) for total mortality. Conclusions This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia.

Relation of Cardiac Complications in the Early Phase of Community-Acquired Pneumonia to Long-Term Mortality and Cardiovascular Events

“…Platelet activation may play a role by favoring plaque instability and thrombosis as also suggested by an observational study showing that CAP patients on aspirin have lower intra-hospital cardiac complication compared to non-aspirin users. 17,18 Furthermore, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 9 pneumonia can cause coronary vasoconstriction by mechanisms involving interaction among bacteria, platelet and endothelial function. 18,19 Our findings provide an explanation for high long-term mortality rate in patients hospitalized for pneumonia.…”

Advances in the causes and management of community acquired pneumonia in adults

“…133 Treatment with antiplatelet agents may be associated with better outcomes in patients with pneumonia in both prospective interventional and retrospective observational studies. [125][126][127][128][129][130][131][132][133][134][135] A dose higher than 100 mg of aspirin seems to be needed, as this dose failed to reduce mortality or myocardial infarction rates in pneumonia and did not lower platelet activation markers. 132 Retrospective data suggest that clopidogrel may be more effective than aspirin at reducing myocardial events in the setting of pneumonia, 136 and ticagrelor even more so.…”

Pro-Resolving Molecules—New Approaches to Treat Sepsis?

“…In a separate study including 1,005 patients with community-onset pneumonia intake of 100 mg/day of aspirin was associated with a lower mortality rate within 30 days [136]. …”