Association between long-term (current) aspirin use and sepsis-related delirium in elderly patients: a retrospective cohort study

Background

Driven by the global aging trend, the prognosis of elderly patients with sepsis has garnered increasing attention. Sepsis-associated delirium (SAD), a common manifestation of elderly patients with sepsis, is frequently linked to poor clinical outcomes. Despite its prevalence, effective preventive measures remain lacking. Pharmacological interventions have emerged as promising components of a comprehensive strategy for the treatment and prevention of delirium. Among them, aspirin—renowned for its anti-inflammatory properties, affordability, and safety—may hold particular promise, given the central role of inflammation in the pathogenesis of both sepsis and delirium. Early initiation of anti-inflammatory therapy may offer a more effective approach to preventing SAD and enhancing patient outcomes.

Aims

To investigate the association between long-term (current) aspirin use and the incidence of SAD in elderly septic patients.

Methods

We extracted and analyzed data from 9145 elderly septic patients. The primary outcome, SAD, was analyzed using multivariable logistic regression to explore the correlation between long-term (current) aspirin use and the incidence of SAD. To ensure the robustness of the results, inverse probability of treatment weighting was used to adjust Intergroup relations. Finally, subgroup analyses were conducted.

Results

765 elderly septic patients were long-term (current) aspirin users, with a SAD incidence rate of 31.9% (244/765). In contrast, 8380 elderly septic patients without a history of long-term (current) aspirin use had a SAD incidence rate of 46.1% (3863/8380). After adjusting for 49 covariates, the multivariable logistic regression results showed that long-term (current) aspirin use was negatively associated with the risk of SAD (adjusted OR: 0.78, p < 0.001). Even after balancing group differences through inverse probability treatment weighting, the results remained stable.

Conclusions

In elderly patients, long-term (current) aspirin use is negatively associated with the incidence of SAD and is also linked to improved clinical outcomes.