Effect of combined aspirin and statin therapy on mortality reduction in sepsis-induced myocardial injury

FIGURE 1. Flowchart of patients’ recruitment. ICU: Intensive Care Unit; LOS: Length of Stay; SIMI: Sepsis-Induced Myocardial Injury; cTnT: Cardiac Troponin T; ACS: Acute Coronary Syndrome; COPD: Chronic Obstructive Pulmonary Disease; CHF: Chronic Heart Failure.

FIGURE 2. The impact of aspirin monotherapy, statin monotherapy, and combined aspirin and statin therapy on mortality in SIMI patients (A) 28-day mortality (B) 90-day mortality (C) 1-year mortality. HR and 95% CI derived from multivariable Cox proportional hazards models, comparing aspirin monotherapy, statin monotherapy, and aspirin and statin combination against non-users. All models were adjusted for age, gender, body mass index, hypertension, diabetes mellitus, pneumonia, stroke, coronary artery disease, cancer, use of mechanical ventilation or continuous renal replacement therapy, SOFA score, SAPS II score, and lactate level.

FIGURE 3. Association of aspirin monotherapy, statin monotherapy, and combination therapy with mortality in the propensity score-matched cohort of SIMI patients. Each row represents a pairwise comparison of different treatment strategies (combination therapy vs. non-users, aspirin monotherapy vs. non-users, statin monotherapy vs. non-users, aspirin monotherapy vs. combination therapy, and statin monotherapy vs. combination therapy). The x-axis displays the HR (95% CI) for mortality at 28-day (yellow), 90-day (teal), and 1-year (purple) follow-up. All analyses were performed in the propensity score-matched cohort to balance baseline confounding variables.

FIGURE 4. Kaplan–Meier survival curves for 28-day, 90-day, and 1-year mortality in patients with SIMI (A) 28-day survival (B) 90-day survival (C) 1-year survival. The curves represent four treatment groups: non-users (red line), aspirin monotherapy (green line), statin monotherapy (blue line), and aspirin-statin combination therapy (blue-green line).

FIGURE 5. Subgroup analysis of the relationship between combined aspirin and statin therapy and 1-year mortality in SIMI patients. Multivariable Cox proportional hazards models, adjusted for age, gender, body mass index, hypertension, diabetes mellitus, pneumonia, stroke, coronary artery disease, cancer, use of mechanical ventilation or continuous renal replacement therapy, SOFA score, SAPS II score, and lactate level, were fitted within each subgroup. SOFA: Sequential Organ Failure Assessment; SAPS II: Simplified Acute Physiology Score II; CRRT: Continuous Renal Replacement Therapy; ACEI: Angiotensin-Converting Enzyme Inhibitor; ARB: Angiotensin II Receptor Blocker; CCB: Calcium Channel Blocker.

FIGURE 6. Combined aspirin and statin therapy and in-hospital mortality risk in the external cohort of patients with SIMI. Non-users indicating the SIMI patients without the administration of aspirin or statin was applied as the reference for each comparation. The association between the treatment and in-hospital mortality was evaluated by multivariate Cox regression models with the adjustment of age and gender.