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Acetylsalicylic acid use is associated with improved survival in bacteremic pneumococcal pneumonia : A long-term nationwide study

Acetylsalicylic acid use is associated with improved survival in bacteremic pneumococcal pneumonia : A long-term nationwide study


Title: Acetylsalicylic acid use is associated with improved survival in bacteremic pneumococcal pneumonia : A long-term nationwide study
Author: Rögnvaldsson, Kristján G
Bjarnason, Agnar   orcid.org/0000-0002-2892-3304
Kristinsson, Karl
Bragason, Hörður T
Erlendsdóttir, Helga
Þorgeirsson, Guðmundur
Gottfreðsson, Magnús
Date: 2022-03-21
Language: English
Scope:
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Internal Medicine and Emergency Services
Clinical Laboratory Services, Diagnostics and Blood Bank
Cardio-Vascular Center
Other departments
Series: Journal of Internal Medicine; ()
ISSN: 0954-6820
DOI: https://doi.org/10.1111/joim.13485
Subject: Smitsjúkdómalæknisfræði; Náttúrufræðingar; Hjartalæknisfræði; Vísindadeild; Pneumókokkar; Lungnabólga; Aspirín; Lífslíkur; Streptococcus pneumoniae; aspirin; pneumonia; population-based; survival
URI: https://hdl.handle.net/20.500.11815/3197

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Citation:

Rögnvaldsson , K G , Bjarnason , A , Kristinsson , K , Bragason , H T , Erlendsdóttir , H , Þorgeirsson , G & Gottfreðsson , M 2022 , ' Acetylsalicylic acid use is associated with improved survival in bacteremic pneumococcal pneumonia : A long-term nationwide study ' , Journal of Internal Medicine . https://doi.org/10.1111/joim.13485

Abstract:

BACKGROUND: Pneumonia is commonly caused by Streptococcus pneumoniae (pneumococcus) and associated with subsequent cardiovascular complications and increased mortality. Potential short-term survival benefits conferred by acetylsalicylic acid (ASA) use in pneumonia remain controversial, and long-term outcomes have not been studied. OBJECTIVES: To evaluate the association between ASA use and survival for up to 1 year following bacteremic pneumococcal pneumonia. METHODS: All bacteremic pneumococcal episodes in Iceland from 1975 to 2019 were reviewed. The study cohort consisted of individuals at least 18 years of age with symptoms and imaging results consistent with pneumonia. Differences in survival were assessed at 30 days, 90 days and 1 year using propensity score weighting (inverse probability weighting). Splitting and stratifying on survival at 7 days was done for the 30-day survival, because of nonproportionality. RESULTS: In total, 815 bacteremic pneumococcal pneumonia episodes (median age 67 years, females 48%) were identified. Cox regression using propensity score weighting on the association of ASA with survival at 30 days showed an average hazard ratio (HR) of 0.60 (95% confidence interval [CI] 0.34-1.05). A significantly improved survival was observed within 7 days (HR = 0.42, 95% CI 0.19-0.92) but not during days 7-30 (HR = 1.08, 95% CI 0.46-2.55). ASA was associated with survival at 90 days (HR = 0.53, 95% CI 0.32-0.87) and 1 year (HR = 0.48, 95% CI 0.31-0.75). CONCLUSION: Use of ASA upon admission for bacteremic pneumococcal pneumonia is associated with significantly reduced mortality for up to 1 year after diagnosis. ASA therapy in patients with pneumonia and other infectious syndromes warrants further study.

Description:

© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine. Funding Information: The Icelandic Centre for Research (Rannís, grant number 217716‐051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific Fund of Landspitali—The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation and the Foundation of St. Josef´s Hospital funded Kristján Godsk Rögnvaldsson´s work on this project. The funding sources had no role in the study's design, conduct, or reporting. Publisher Copyright: © 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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