Background Acute Respiratory Failure (ARF) is a serious complication of various diseases, characterized by a high mortality rate. Aspirin influences cyclooxygenase, which have a crucial role in inflammation, blood clotting, and immune system modulation. ARF is characterized by an uncontrolled inflammatory and pro-coagulant response, but aspirin can mitigate this inflammatory response by inhibiting platelet function, potentially leading to improved outcomes.Numerous studies have produced conflicting data concerning the impact of aspirin on individuals suffering from Acute Respiratory Failure. We performed an analysis of the MIMIC IV database to explore the association between aspirin use and the outcomes in ARF patients, as well as to ascertain the optimal dosing regimen for aspirin treatment.

Materials and methods ARF patients’ clinical data were extracted from MIMICIV2.2. Propensity score matching was utilized to ensure comparability of baseline characteristics between the group receiving aspirin and the group not receiving aspirin. Subsequently, the link between aspirin and patient death was examined through the application of Kaplan-Meier estimations and Cox proportional hazard regression analyses.

Results We identified a cohort of 6,663 individuals suffering from ARF from the MIMIC IV database.Following propensity score matching in a sample of 4,008 participants, multivariate Cox proportional hazards analysis revealed a lower hazard of dying within 90 days for those in the aspirin group versus the non-users group (adjusted Hazard Ratio: 0.723; 95% Confidence Interval: 0.652 to 0.802). Additionally, the Kaplan-Meier survival curves indicated that the 90-day survival rate was higher among aspirin users compared to non-users (log-rank test p< 0.001). And the median duration of survival for patients undergoing aspirin therapy was considerably extended compared to those who did not receive it, amounting to 15.60 days versus 10.36 days, respectively In the aspirin group, the median ICU stay length was longer than non-users group (6.93 days vs. 6.08 days, p <0.001).Patients in the aspirin use group had a significantly shorter duration of mechanical ventilation compared to those in the non-aspirin use group(54.95 days vs. 58.00 days, p <0.001).

Conclusion Aspirin may reduce the 30-day or 90-day mortality risk in ARF patients and also shorten the duration of mechanical ventilation. Aspirin could be an effective medication in the treatment of ARF patients.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

MIMIC-IV, the fourth iteration of the Medical Information Mart for Intensive Care, is a comprehensive, single-site database that offers open access to a vast trove of information. Specifically, it encompasses records from over 730,000 ICU admissions at the Beth Israel Deaconess Medical Center in the U.S., with data spanning from 2008 through 201918. This resource can be found at https://physionet.org/content/mimiciv/2.2/. Utilization of this database received endorsements from the institutional review boards at MIT and BIDMC. This project was conducted in accordance with the ethical guidelines outlined in the Declaration of Helsinki. Given the de-identified status of the participants and the structured data in the database, further ethical committee clearance was not deemed necessary for this investigation.

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