Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department

Kor, Daryl J.; Carter, Rickey E.; Park, Pauline K.; Festić, Emir; Banner‐Goodspeed, Valerie; Hinds, Richard; Talmor, Daniel; Gajic, Ognjen; Ware, Lorraine B.; Gong, Michelle N.

doi:10.1001/jama.2016.6330

Cited by 192 publications

(141 citation statements)

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“…Overall, 37 (9.5%) patients developed ARDS, of whom 20 (10.3%) were in the aspirin group and 17 (8.7%) were in the placebo group. Secondary outcomes, including ventilator-free days to hospital day 28, ICU and hospital lengths of stay, 28-day and 1-year mortality and incidence of adverse events did not differ between the two groups [35].…”

Section: Preventionmentioning

confidence: 81%

“…The preventive role of aspirin and statins has been re-evaluated in two studies [35,36]. KOR et al [35] studied the role of early administration of aspirin in patients at risk of ARDS in a multicentre, double-blind, placebo-controlled, randomised study.…”

Section: Preventionmentioning

confidence: 99%

“…KOR et al [35] studied the role of early administration of aspirin in patients at risk of ARDS in a multicentre, double-blind, placebo-controlled, randomised study. 400 adult patients at risk of ARDS according to a lung injury prediction score [37] ⩾4 were randomised to receive either aspirin at a loading dose of 325 mg within 24 h of admission to the emergency department followed by 81 mg daily for 7 days, or placebo.…”

Section: Preventionmentioning

confidence: 99%

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Acute respiratory distress syndrome

2017

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Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in atrisk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care. Definition and epidemiologySince its first description by ASHBAUGH et al. [1] in 1967, the acute respiratory distress syndrome (ARDS) has been widely recognised as a major clinical problem worldwide, carrying a high morbidity and mortality burden [2][3][4]. Although the recent Berlin definition [5] is probably much better than previous ones, there is still a high variability in both epidemiology and clinical outcomes in diverse healthcare settings [4]. In fact, the incidence of ARDS ranges from 1.5 cases per 100 000 [2] to nearly 79 cases per 100 000 [3], with European countries reporting a lower incidence than USA [6]. Moreover, studies from Brazil reported incidence rates ranging from 1.8 to 31 per 100 000 [7,8].Although the overall survival rate is improving [9,10], there is a notable difference when considering in-hospital mortality over several observational studies [2][3][4][8][9][10][11]. This may be explained by differences in risk factors, availability of diagnostics, ability to recognise ARDS and some selection biases affecting clinical trials [12]. Recently, a large international observational study (the LUNG SAFE trial) evaluated the incidence of ARDS across 459 intensive care units (ICUs) in 50 countries [13]. To assess the clinical recognition of ARDS according to the latest definition, any patient inclusion into the trial was made through a computer algorithm following the Berlin criteria [5], and then compared to the diagnosis made by the attending physicians. Among 4499 patients who developed acute hypoxaemic respiratory failure, ARDS occurred in 1...

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Section: Preventionmentioning

confidence: 81%

Section: Preventionmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

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Acute respiratory distress syndrome

2017

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“…There have been multiple negative studies with pharmacologic agents including rosuvastatin, methylprednisolone, aerosolized surfactant, prostaglandin E1, and ketoconazole (5)(6)(7)(8)(9)(10). Recently the lung injury prediction score (LIPS)-A trial published by Kor et al failed to demonstrate a reduced incidence of ARDS in a cohort of nearly 400 patients who received aspirin or placebo adding to the list of negative studies (11).…”

mentioning

confidence: 99%

“…The first and most obvious limitation of the LIPS-A trial is that the incidence of ARDS was unexpectedly low in both the control and treatment groups (8.7% and 10.3% respectively) (11). In their sample size calculation, the authors assumed an ARDS incidence of 18% and an absolute risk reduction of 10% with aspirin.…”

mentioning

confidence: 99%