Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2022; 11(2): 92-101
Published online Mar 9, 2022. doi: 10.5492/wjccm.v11.i2.92
Retrospective analysis of aspirin's role in the severity of COVID-19 pneumonia
Maya Gogtay, Yuvaraj Singh, Asha Bullappa, Jeffrey Scott
Maya Gogtay, Yuvaraj Singh, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
Asha Bullappa, Community Medicine and Biostatistics, SS Institute of Medical Sciences, Davangere 577003, Karnataka, India
Jeffrey Scott, Department of Critical Care Medicine and Pulmonology, Reliant medical group- Saint Vincent Hospital, Worcester, MA 01604, United States
Author contributions: Gogtay M contributed to inception of study idea, data collection, statistical interpretations, and manuscript editing and final submission; Singh Y drafting manuscript, assisting with statistics, proof reading and abstract creation; Bullappa A statistical analysis of data; Scott J inception of study idea, proof reading of manuscript and mentor for the study.
Institutional review board statement: The study was reviewed and approved by the Saint Vincent- MetroWest Medical Center Institutional Review Board [(Approval No. 2020-072)].
Informed consent statement: Requirement of informed consent was waived by the Saint Vincent- MetroWest Medical Center Institutional Review Board [(Approval No. 2020-072)].
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maya Gogtay, MD, Doctor, Department of Internal Medicine, Saint Vincent Hospital, 123 Summer street, Worcester, MA 01604, United States. drgogtay@gmail.com
Received: November 18, 2021
Peer-review started: November 18, 2021
First decision: December 27, 2021
Revised: January 3, 2022
Accepted: January 20, 2022
Article in press: January 20, 2022
Published online: March 9, 2022
Processing time: 104 Days and 11 Hours
ARTICLE HIGHLIGHTS
Research background

In a retrospective study by Chow et al, it was found that aspirin use may be associated with improved outcomes, reduced rates of mechanical ventilation, and decreased intensive care unit (ICU) admissions in hospitalized coronavirus disease 2019 (COVID-19) patients. Given the encouraging findings, the world’s largest randomized controlled open-label trial was performed using approximately 15000 patients in the UK (RECOVERY TRIAL). The patients in the study were allocated to receive aspirin after diagnosis of COVID-19 during in-hospital admission, and the results showed no associated reductions in the 28-d mortality or the progression to mechanical ventilation of such patients. With the above conflicting findings, the present study was designed to evaluate the impact of daily aspirin intake prior to hospitalization on the rate of COVID-19 positive patients’ progression to the ICU.

Research motivation

With the never ending COVID-19 pandemic, it is imperative we find ways to keep patients out of the ICU. We have learnt that COVID-19 illness has major thrombotic and inflammatory effects. Aspirin would seem like an ideal choice to curb these effects. With this in mind, we conducted our study. But surprisingly we found that aspirin has no beneficial effects when it comes to preventing severe COVID-19 illness like ICU admissions. We postulate that patients taking aspirin were also older and had significant comorbidities, putting them at high risk for severe COVID-19. Furthermore, this study was carried out back when the most effective treatment modalities like steroids and remdesivir were not used. Hence, we conclude that aspirin's antiviral, anti-inflammatory and anti-thrombotic properties may not be strong enough to combat the COVID-19 illness.

Research objectives

Present study was designed to evaluate the impact of daily aspirin intake prior to hospitalization on the rate of COVID-19 positive patients’ progression to the ICU.

Research methods

The idea of using the below methods were modeled after the study by Chow et al and the recovery trial on Aspirin in patients admitted to the hospital with COVID-19. Research methods adopted were the following: (1) Categorical variables, such as demographic information, comorbidities, receipt of investigational therapeutics, type of oxygen support, mechanical ventilation need, and outcomes, were reported as the number and percentage of patients and were compared between groups using the χ2 test. P values < 0.05 were considered statistically significant; and (2) Multinomial logistic regression analysis to control for interplay of confounding from other anti-coagulation agents.

Research results

Our study analyzed 125 patients, of which 38 patients were on daily aspirin use, with a minimum dose of 81 mg. The study showed a significant association of aspirin with variables such as age groups, hypertension, hyperlipidemia, and diabetes mellitus. This insinuated that our aspirin patients were older, and most of them had significant comorbidities, putting them at risk of severe COVID-19 illness. At first glance, aspirin showed a possible protective role in progression to ICU on chi-square analysis. It failed to reach significance in multinomial logistic regression analysis. Furthermore, in terms of mortality, patients on aspirin had a higher mortality rate of 32% as compared to only 25% for non-aspirin users. This could be explained by the fact that patients on aspirin were older and had more comorbidities.

Research conclusions

We conclude that aspirin shows no protective role for COVID-19 patients in terms of progression to ICU, survival outcome, and use of mechanical ventilation. Our findings concurred with the results of the RECOVERY trial. The advantage of our study is that it was conducted on the cohort of patients that presented at our hospital during the initial phase of the COVID-19 pandemic back in March of 2020. At that time, the use of corticosteroids and remdesivir were not established as the standard of care, and hence our study is not confounded by the effects of these medications.

Research perspectives

Given the conflicting results of recent studies on aspirin and COVID-19 illness, it would seem beneficial for future studies to study the effect of chronic daily aspirin use on COVID-19 outcomes. Since our N-126, larger studies with N-1000s may be able to show definitive significance between aspirin and COVID-19. In theory, aspirin is an over the counter, cheap medication with a wide range of properties to battle the ill effects of the virus.