Systemic inflammatory response syndrome (SIRS) occurs in patients after trauma or sepsis affecting the immune system and causing dysregulation of the host immune response in a matter of hours to days. Critical care research has focused on several possible strategies to improve outcomes in this setting, one of which is goal-directed early therapy.1 Other strategies that might provide some benefits are targeting activated platelets that play a complex role in sepsis pathogenesis. 2
Acetyl salicylic acid (ASA), one of the most prescribed drugs worldwide,3 could have some beneficial effects through its irreversible acetylation of platelet cyclo-oxygenase and down-regulating activated platelets. Moreover, low doses of ASA have been shown to have both anti-inflammatory and pro-inflammation resolution effects by the induction of aspirin-triggered lipoxins (ATL) and by affecting other mechanisms involved in the inflammatory cascade.4,5
In a recently published article by Eisen and colleagues,6 the authors sought to determine whether ASA is associated with lower mortality in patients presenting with SIRS. The retrospective analysis included 7945 intensive care unit (ICU) admissions from an Australian tertiary center from April 2000 to November 2009.
A total of 2082 out of 5523 SIRS patients were administered ASA in a 24-hour period around SIRS recognition. The authors in their propensity analysis showed a 10.9% mortality for acetyl salicylic acid users and 17.2% mortality in nonusers (absolute risk difference 26.2%; 95% CI: 29.5% to 23.5%). Propensity matching also found that acetyl salicylic acid administration was associated with increased risk of renal injury (6.2% vs. 2.9%; absolute risk difference 13.3%; 95% CI: 2.5%-5.0%). In the subset of patients with sepsis (n=970) and after propensity matching, ASA was associated with a lower mortality (27.4% vs. 42.2%; absolute risk difference 214.8%; 95% CI: 218.9% to 28.6%).
The authors conclude that there is a strong association between ASA and survival in intensive care unit in a subset of patients with SIRS and sepsis. Prospective randomized trials are needed to further assess the use of ASA in this setting.
1. Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 2010;36:222–231.
2. Vincent JL, Yagushi A, Pradier O. Platelet function in sepsis. Crit Care Med 2002;30(Suppl 5):S313–S317.
3. Goodman SG, Menon V, Cannon CP, et al. Acute ST-segment elevation myocardial infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(Suppl 6):708S–775S.
4. Claria J, Serhan CN. Aspirin triggers previously undescribed bioactive eicosanoids by human endothelial cell-leukocyte interactions. Proc Nat Acad Sci USA 1995;92:9475–9479.
5. Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: Dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol 2008;8:349–361.
6. Eisen D, Reid D, McBryde ES. Acetyl salicylic acid usage and mortality ...