title: Aspirin therapy in patients with acute respiratory distress syndrome (ARDS) is associated with reduced intensive care unit mortality: a prospective analysis.
abstract: BACKGROUND
  Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce the risk of developing ARDS, but the effect of aspirin on established ARDS is unknown.
  
  
  METHODS
  In a single large regional medical and surgical ICU between December 2010 and July 2012, all patients with ARDS were prospectively identified and demographic, clinical, and laboratory variables were recorded retrospectively. Aspirin usage, both pre-hospital and during intensive care unit (ICU) stay, was included. The primary outcome was ICU mortality. We used univariate and multivariate logistic regression analyses to assess the impact of these variables on ICU mortality.
  
  
  RESULTS
  In total, 202 patients with ARDS were included; 56 (28%) of these received aspirin either pre-hospital, in the ICU, or both. Using multivariate logistic regression analysis, aspirin therapy, given either before or during hospital stay, was associated with a reduction in ICU mortality (odds ratio (OR) 0.38 (0.15 to 0.96) P = 0.04). Additional factors that predicted ICU mortality for patients with ARDS were vasopressor use (OR 2.09 (1.05 to 4.18) P = 0.04) and APACHE II score (OR 1.07 (1.02 to 1.13) P = 0.01). There was no effect upon ICU length of stay or hospital mortality.
  
  
  CONCLUSIONS
  Aspirin therapy was associated with a reduced risk of ICU mortality. These data are the first to demonstrate a potential protective role for aspirin in patients with ARDS. Clinical trials to evaluate the role of aspirin as a pharmacological intervention for ARDS are needed.
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queen's University Belfast, 97 Lisburn Road, Belfast, UK. boyle.andrewj@gmail.com.|Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. boyle.andrewj@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boyle
authors.affiliation: Epidemiology ASL TO3, Via Sabaudia, 164, Grugliasco, TO, 10095, Italy. stefadiga@gmail.com.
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queen's University Belfast, 97 Lisburn Road, Belfast, UK. umar79@hotmail.com.
authors.forename: Umar I
authors.initials: UI
authors.lastname: Hamid
authors.affiliation: Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. Linda-Jayne.Mottram@belfasttrust.hscni.net.
authors.forename: Linda-Jayne
authors.initials: LJ
authors.lastname: Mottram
authors.affiliation: Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. lia.mcnamee@belfasttrust.hscni.net.
authors.forename: Lia
authors.initials: L
authors.lastname: McNamee
authors.affiliation: Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. grianiae.white@belfasttrust.hscni.net.
authors.forename: Griania
authors.initials: G
authors.lastname: White
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queen's University Belfast, 97 Lisburn Road, Belfast, UK. mark.cross@belfasttrust.hscni.net.|Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. mark.cross@belfasttrust.hscni.net.
authors.forename: L J Mark
authors.initials: LJ
authors.lastname: Cross
authors.affiliation: Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. James.McNamee@belfasttrust.hscni.net.
authors.forename: James J
authors.initials: JJ
authors.lastname: McNamee
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queen's University Belfast, 97 Lisburn Road, Belfast, UK. c.okane@qub.ac.uk.
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: O'Kane
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queen's University Belfast, 97 Lisburn Road, Belfast, UK. d.f.mcauley@qub.ac.uk.|Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. d.f.mcauley@qub.ac.uk.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McAuley
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000401:mortality; D012306:Risk
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin