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May 26, 2026Frontiers in Cardiovascular MedicineOpen Access

Aspirin is associated with improved outcomes in sepsis patients with atrial fibrillation: an analysis of the MIMIC-IV and eICU-CRD databases

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Why the study?

Evidence regarding aspirin in sepsis patients with AF remains limited, and exposure timing complicates interpretation.

Does early aspirin exposure reduce mortality in sepsis patients with atrial fibrillation?

Population

8,827 sepsis patients with AF in MIMIC-IV with external validation in eICU-CRD

Comparison

Aspirin exposure before or within 48 h of ICU admission vs no aspirin within 48 h

Design

Retrospective cohort study with external validation

Follow-up

30 days

Key result

Early aspirin exposure within 48 hours of ICU admission was associated with a significantly lower 30-day all-cause mortality (HR 0.624) in sepsis patients with atrial fibrillation.

Authors

FCFangchao ChenGuangxi Medical UniversityYZYufeng ZhongFourth Affiliated Hospital of Guangxi Medical UniversityDWDianyang WangFourth Affiliated Hospital of Guangxi Medical University

Discussion

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Member takes

Overview

Should not yet change practice in sepsis with AF; hypothesis-generating and supports RCTs to confirm mortality benefit.

Study Design

Type

Cohort (n=8,827)

Multicenter

Yes

Structured PICO

Does early aspirin exposure reduce mortality in sepsis patients with atrial fibrillation?

P
Population
8,827 sepsis patients with atrial fibrillation (AF) from the MIMIC-IV database, with external validation in eICU-CRD.
I
Intervention
Early aspirin exposure (before ICU admission or within 48 h after ICU admission)
C
Comparator
No aspirin exposure within 48 h
O
Outcome
30-day all-cause mortality (in MIMIC-IV)hard clinical

Main Result

Effect estimate: HR 0.624 (95% CI 0.547-0.712)

p-value: p=<0.001

Early aspirin exposure is associated with lower 30-day mortality in sepsis patients with atrial fibrillation, particularly when newly initiated during early ICU care.

Limitations

  • Retrospective observational design cannot fully exclude time-related bias and confounding by indication
  • Association was more reproducible for 30-day all-cause mortality than for in-hospital mortality
  • External validation results were supportive but not fully concordant
  • Exposure classification based on recorded medication data may not fully reflect adherence, dosing intent, or clinical context
  • eICU-CRD cohort did not permit replication of long-term post-discharge outcomes

Cite This Study

Chen et al. (2026) conducted a cohort in Sepsis with atrial fibrillation (n=8,827). Early aspirin exposure vs. No aspirin exposure within 48 hours after ICU admission was evaluated on 30-day all-cause mortality (HR 0.624, 95% CI 0.547-0.712, p=<0.001). Early aspirin exposure within 48 hours of ICU admission was associated with a significantly lower 30-day all-cause mortality (HR 0.624) in sepsis patients with atrial fibrillation.

synapsesocial.com/papers/6a1998e20ef26ba216f649f2https://doi.org/10.3389/fcvm.2026.1796096
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