Skip to main content
  • Letter
  • Published:

Benefit of low-dose aspirin and non-steroidal anti-inflammatory drugs in septic patients

Abstract

Analyzing medical records of 979 patients with severe sepsis or septic shock provided some evidence that the use of low-dose aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was associated with decreased hospital mortality. However, the benefit was abolished when aspirin and NSAIDs were given together.

Various retrospective clinical studies have shown that pre- and in-hospital use of low-dose aspirin was associated with a reduced mortality [14], but there is no evidence that NSAIDs may have a similar benefit [1, 5]. We studied the medical records of 979 patients with severe sepsis or septic shock who were admitted to a university hospital surgical intensive care unit (ICU). Exclusion criteria were ICU stay of less than 48 hours, age of more than 18 years, and pregnancy. The study was approved by the local ethics committee. Investigators were not required to ask patients for informed consent.

Findings

Ninety-three patients had received NSAIDs (that is, ibuprofen, diclofenac, or indomethacin) during their ICU stay. There was no difference in APACHE (Acute Physiology and Chronic Health Evaluation) II score at ICU admission, but there were significant differences in age, gender, and length of ICU stay. In-hospital mortality was about 10% lower in NSAID users in comparison with non-users (Table 1). Medication during ICU stay with low-dose aspirin, clopidogrel, or statins, all three of which are believed to have a benefit on the outcome in sepsis, is also indicated in Table 1. A model of stepwise logistic regression with in-hospital mortality as a dependent variable and age, gender, APACHE II score, and the administration of NSAIDs, aspirin, clopidogrel, and statins as independent variables indicated that administration of aspirin during ICU stay was associated with a decreased mortality indicated by an odds ratio (OR) of 0.57 (95% confidence interval 0.39 to 0.83) but that NSAIDs, clopidogrel, statins, and gender were without significant effects. However, when patients on aspirin were excluded from the analysis, NSAIDs were also associated with a reduction of the in-hospital mortality (OR = 0.50, 0.26 to 0.94). On the other hand, the benefit of aspirin (acetylsalicylic acid) was completely abolished in those patients who also received NSAIDs (OR = 1.12, 0.55 to 2.25).

Table 1 Characteristics of the patients included in the study

The data of the present study indicate that, given separately, both aspirin and NSAIDs may reduce mortality in patients with sepsis. The interaction between aspirin and NSAIDs needs to be considered in forthcoming trials looking for benefits of either compound in patients with sepsis. We speculate that the lack of benefit of parallel use of aspirin and NSAIDs is due to a higher bleeding risk or anti-inflammatory action or both.

Abbreviations

APACHE II:

Acute Physiology and Chronic Health Evaluation II

ICU:

intensive care unit

NSAID:

non-steroidal anti-inflammatory drug

OR:

odds ratio.

References

  1. Eisen DP: Manifold beneficial effects of acetyl salicylic acid and non-steroidal anti-inflammatory drugs on sepsis. Intensive Care Med 2012, 38: 1249-1257. 10.1007/s00134-012-2570-8

    Article  CAS  PubMed  Google Scholar 

  2. Winning J, Neumann J, Kohl M, Claus RA, Reinhart K, Bauer M, Lösche W: Antiplatelet drugs and outcome in mixed admissions to an intensive care unit. Crit Care Med 2010, 38: 32-37. 10.1097/CCM.0b013e3181b4275c

    Article  CAS  PubMed  Google Scholar 

  3. Winning J, Reichel J, Eisenhut Y, Hamacher J, Kohl M, Deigner HP, Claus RA, Bauer M, Lösche W: Anti-platelet drugs and outcome in severe infection: clinical impact and underlying mechanisms. Platelets 2009, 20: 50-57. 10.1080/09537100802503368

    Article  CAS  PubMed  Google Scholar 

  4. Sanchez MA, Thomas CB, O'Neal HR: Do aspirin and statins prevent severe sepsis? Curr Opin Infect Dis 2012, 25: 345-350. 10.1097/QCO.0b013e3283520ed7

    Article  CAS  PubMed  Google Scholar 

  5. Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson WJ, Wright PE, Christman BW, Dupont WD, Higgins SB, Swindell BB: The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med 1997, 336: 912-918. 10.1056/NEJM199703273361303

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the German Federal Ministry of Education and Research within the 'Center for Sepsis Control and Care'.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wolfgang Lösche.

Additional information

Competing interests

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sossdorf, M., Otto, G.P., Boettel, J. et al. Benefit of low-dose aspirin and non-steroidal anti-inflammatory drugs in septic patients. Crit Care 17, 402 (2013). https://doi.org/10.1186/cc11886

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc11886

Keywords