title: 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.
  
  
  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.
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
authors.forename: Alessandro
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (R.C., C.C., F.B., F.V.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Cangemi
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (R.C., C.C., F.B., F.V.).
authors.forename: Camilla
authors.initials: C
authors.lastname: Calvieri
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (R.C., C.C., F.B., F.V.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Barillà
authors.affiliation: Department of Emergency Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.G.S., G.B.).
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Scarpellini
authors.affiliation: Department of Emergency Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.G.S., G.B.).
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bertazzoni
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
authors.forename: Paolo
authors.initials: P
authors.lastname: Palange
authors.affiliation: Department of Clinical Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (G.T.).
authors.forename: Gloria
authors.initials: G
authors.lastname: Taliani
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (M.F., A.R., A.F., P.P., M.V.).
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy (R.C., C.C., F.B., F.V.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000401:mortality / Q000517:prevention & control; D016001:Confidence Intervals; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011014:Pneumonia / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012016:Reference Values; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: aspirin; pneumonia; septic shock; severe sepsis