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

• Published in: Journal of Internal Medicine
• Main Authors: Rögnvaldsson, Kristján Godsk, Bjarnason, Agnar, Kristinsson, Karl Gústaf, Bragason, Hörður T, Erlendsdóttir, Helga, Þorgeirsson, Guðmundur, Gottfreðsson, Magnús
• Other Authors: Other departments, Faculty of Medicine, Internal Medicine and Emergency Services, Clinical Laboratory Services, Diagnostics and Blood Bank, Cardio-Vascular Center, Landspitali - The National University Hospital of Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2022
• Subjects: Pneumókokkar; Lungnabólga; Vísindadeild; Aspirín; Hjartalæknisfræði; Lífslíkur; Smitsjúkdómalæknisfræði; Náttúrufræðingar; Streptococcus pneumoniae; aspirin; pneumonia; population-based; survival; Bacteremia/complications; Humans; Aspirin/therapeutic use; Pneumococcal/complications; Female; Aged; Cohort Studies; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/3197; https://doi.org/10.1111/joim.13485

© 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. 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 ...