Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 15, Number 3, June 2024, pages 179-188


Effect of Aspirin Use on the Adverse Outcomes in Patients Hospitalized for COVID-19

Figure

Figure 1.
Figure 1. Kaplan-Meier curve showing cumulative survival and length of stay of patients on aspirin compared to patients not on aspirin. Patients on aspirin stayed longer in the hospital compared to those not on aspirin from approximately 5 up to 40 days.

Tables

Table 1. Demographics and Other Baseline Characteristics of COVID-19 Patients Included in the Study
 
On aspirin (n = 128)Not on aspirin (n = 248)
BMI: body mass index; CAD: coronary artery disease; CHF: congestive heart failure; CKD: chronic kidney disease; COVID-19: coronavirus disease 2019; DVT: deep vein thrombosis; PE: pulmonary embolism; SD: standard deviation.
Gender, % (n)
  Male47.7 (61)40.7 (101)
  Female52.3 (67)59.3 (147)
Age (mean ± SD)66.79 ± 12.2759.79 ± 18.80
Race/ethnicity, % (n)
  Non-Hispanic Whites35.2 (45)28.2 (70)
  Non-Hispanic Blacks40.6 (52)35.1 (87)
  Native American22.7 (29)24.6 (61)
  Others/Hispanic-Latino/Asian1.6 (2)12.1 (30)
BMI (mean ± SD)32.71 ± 8.8432.40 ± 9.78
Obesity
  Overweight (BMI 25.0 - 29.9), % (n)26.6 (34)27.8 (69)
  Class I obesity (BMI 30 - 34.9), % (n)28.9 (37)19.8 (49)
  Class II obesity (BMI 35 - 39.9), % (n)13.3 (17)10.9 (27)
  Class III obesity (BMI ≥ 40), % (n)16.4 (21)17.3 (43)
Pre-existing/chronic medical problems, % (n)
  Diabetes mellites63.3 (81)41.9 (104)
  Hypertension89.8 (115)73.8 (183)
  Hyperlipidemia70.3 (90)48.4 (120)
  Atrial fibrillation10.9 (14)5.6 (14)
  History of DVT/PE3.9 (5)5.2 (13)
  CAD41.4 (53)15.7 (39)
  CHF18.8 (24)10.1 (25)
  Chronic lung disease28.1 (36)15.7 (39)
  CKD21.1 (27)21.4 (53)
  On chronic dialysis3.1 (4)6.9 (17)
Medication prior to admission
  On antiplatelet therapy, % (n)
    Clopidogrel013.3 (33)
    Ticagrelor01.6 (4)
    Dual antiplatelet therapy10.9 (14)0
  On anticoagulation, % (n)
    Coumadin2.3 (3)1.2 (3)
    Apixaban4.7 (6)6.0 (15)
    Rivaroxaban3.1 (4)1.2 (3)
    Enoxaparin0.8 (1)0.8 (2)

 

Table 2. Comparative Analysis of Variables of Interest Between COVID-19 Patients on Aspirin and Those Not on Aspirin
 
On aspirin (n = 128)Not on aspirin (n = 248)P
AKI: acute kidney injury; CHF: congestive heart failure; COVID-19: coronavirus disease 2019; CVA: cerebrovascular accident; DVT: deep vein thrombosis; IQR: interquartile range; LDH: lactate dehydrogenase; NSTEMI: non-ST elevation myocardial infarction; PE: pulmonary embolism; SD: standard deviation; STEMI: ST-segment elevation myocardial infarction.
Hypoxia (SpO2 < 94%), % (n)71.1 (91)54.4 (135)0.002
O2 support, % (n)
  On nasal cannula O2 support64.1 (82)57.3 (142)0.204
  On high flow oxygen (≥ 6 L/min)35.2 (45)28.2 (70)0.163
On mechanical ventilation, % (n)21.1 (27)15.3 (38)0.159
Duration of mechanical ventilation (days) (median (IQR))7 (7)9 (11)0.036
Inflammatory markers
  D-dimer
    On presentation (median (IQR))0.990 (1.71)1.12 (1.415)0.905
    Peak (median (IQR))1.63 (3.458)1.32 (1.752)0.241
  LDH
    On presentation (mean ± SD)300.57 (168.05)315.89 (244.78)0.930
    Peak (mean ± SD)331.33 (150.22)382.15 (379.18)0.886
  Ferritin
    On presentation (median (IQR))490.6 (666.95)581.6 (1,265.1)0.450
    Peak (median (IQR))649.1 (900.73)818.4 (1,715.0)0.561
  Procalcitonin
    On presentation (median (IQR))0.505 (0.355)0.74 (0.768)0.976
    Peak (median (IQR))0.83 (0.99)0.90 (2.515)0.764
Positive chest X-ray findings, % (n)82.8 (106)74.2 (184)0.060
Inpatient medications
  Received therapeutic enoxaparin35.9 (46)29.8 (74)0.230
  Received antibiotics88.3 (113)79.0 (196)0.026
  Received remdesivir52.3 (67)33.9 (84)0.001
  Received dexamethasone71.9 (92)52.4 (130)0.000
  Received convalescent plasma5.5 (7)8.5 (21)0.295
Acute medical problems, % (n)
  Cardiovascular events (STEMI, type 1 NSTEMI, CHF, CVA)7.8 (10)5.2 (13)0.318
  DVT/PE3.9 (5)5.2 (13)0.575
  AKI44.5 (57)30.2 (75)0.006
  Needed dialysis for AKI3.9 (5)6.9 (17)0.242
Length of hospitalization (days) (median (IQR))5.50 (7.75)4.00 (6.00)0.011
Readmissions, % (n)13.3 (17)12.9 (32)0.913
Death, % (n)23.4 (30)20.2 (50)0.473

 

Table 3. Multivariable Logistic Regression Analysis for Hypoxia in Hospitalized COVID-19 Patients
 
BSEWalddfSig. (P)Exp(B) (OR)95% CI for EXP(B)
LowerUpper
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; SE: standard error.
On aspirin-0.5040.2583.82410.0510.6040.3651.001
Gender (male)-0.2000.2290.76310.3820.8180.5221.283
Recategorized race3.96530.265
Non-Hispanic Whites0.8860.4503.87810.0492.4261.0045.859
Non-Hispanic Blacks0.6630.4492.18310.1401.9400.8054.675
Native Americans0.7520.4702.56210.1092.1210.8455.329
Diabetes mellitus-0.3670.2382.38110.1230.6930.4341.104
Hypertension-0.5690.3043.51410.0610.5660.3121.026
Coronary artery disease-0.1030.2970.12010.7290.9030.5051.614
Chronic kidney disease-0.1980.2960.45010.5020.8200.4591.464
Age dichotomized (< 65 years)0.6680.2437.54710.0061.9501.2113.141
Constant-0.5200.4691.22610.2680.595

 

Table 4. Multivariable Logistic Regression Analysis for Mechanical Ventilation in COVID-19 Patients
 
BSEWalddfSig. (P)Exp(B) (OR)95% CI for EXP(B)
LowerUpper
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; SE: standard error.
On aspirin-0.3610.3081.37810.2400.6970.3811.274
Gender (male)-0.5450.2873.61010.0570.5800.3311.017
Recategorized race0.45630.928
Non-Hispanic Whites0.3000.5890.26010.6101.3500.4254.286
Non-Hispanic Blacks0.1050.5750.03310.8551.1110.3603.426
Native Americans0.2270.6020.14210.7071.2540.3854.084
Diabetes mellitus-0.1610.2950.29810.5850.8510.4771.518
Hypertension-0.3430.4320.63110.4270.7100.3051.654
Coronary artery disease0.5750.3602.55410.1101.7770.8783.596
Chronic kidney disease-0.4370.3381.66910.1960.6460.3331.253
Age dichotomized (< 65 years)0.5140.3052.84310.0921.6710.9203.037
Constant1.8630.6268.84610.0036.440

 

Table 5. Multivariable Logistic Regression Analysis for DVT/PE in Hospitalized COVID-19 Patients
 
BSEWalddfSig. (P)Exp(B) (OR)95% CI for EXP(B)
LowerUpper
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; SE: standard error.
On aspirin-0.1950.6220.09910.7530.8230.2432.781
Gender (male)2.0490.8046.50110.0117.7591.60637.483
Recategorized race2.61330.455
Non-Hispanic Whites-18.0306374.5390.00010.9980.0000.000
Non-Hispanic Blacks-18.4066374.5390.00010.9980.0000.000
Native Americans-17.2586374.5390.00010.9980.0000.000
Diabetes mellitus0.7310.5621.69310.1932.0770.6916.244
Hypertension-0.6660.8490.61410.4330.5140.0972.716
Coronary artery disease0.4520.6890.43110.5121.5720.4076.067
Chronic kidney disease-1.9340.60110.36310.0010.1450.0450.469
Age dichotomized (< 65 years)-0.9570.5912.61810.1060.3840.1211.224
Constant21.8336374.5390.00010.9973,033,928,723.49

 

Table 6. Multivariable Logistic Regression Analysis for Readmission in COVID-19 Patients
 
BSEWalddfSig. (P)Exp(B) (OR)95% CI for EXP(B)
LowerUpper
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; SE: standard error.
On aspirin0.0570.3570.02510.8741.0580.5252.132
Gender (male)-0.0680.3280.04310.8360.9340.4911.777
Recategorized race1.08930.780
Non-Hispanic Whites0.6220.6570.89810.3431.8630.5146.745
Non-Hispanic Blacks0.4680.6340.54410.4611.5960.4615.527
Native Americans0.3200.6550.23910.6251.3770.3814.976
Diabetes mellitus0.2210.3340.43610.5091.2470.6472.401
Hypertension-0.6500.5451.42010.2330.5220.1791.520
Coronary artery disease-0.2590.3730.48010.4880.7720.3711.605
Chronic kidney disease-0.9180.3526.80710.0090.4000.2010.796
Age dichotomized (< 65 years)0.3370.3530.90810.3411.4010.7002.800
Constant2.1010.7248.43410.0048.175

 

Table 7. Multivariable Logistic Regression Analysis for Mortality in COVID-19 Patients
 
BSEWalddfSig. (P)Exp(B) (OR)95% CI for EXP(B)
LowerUpper
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; SE: standard error.
On aspirin-0.1550.2940.27810.5980.8560.4811.524
Gender (male)-0.3190.2721.36910.2420.7270.4271.240
Recategorized race2.96730.397
Non-Hispanic Whites0.0260.6250.00210.9661.0270.3023.495
Non-Hispanic Blacks-0.4740.6090.60610.4360.6220.1882.054
Native Americans-0.4870.6270.60310.4370.6150.1802.099
Diabetes mellitus0.0650.2780.05410.8161.0670.6181.841
Hypertension0.0260.3930.00410.9471.0260.4752.216
Coronary artery disease0.3770.3301.30310.2541.4580.7632.785
Chronic kidney disease-0.5590.3123.19510.0740.5720.3101.055
Age dichotomized (< 65 years)1.0580.29612.7611< 0.0012.8811.6125.148
Constant1.3610.6424.50010.0343.899