Aspirin Tied to Increased Kidney Injury Risk in Chest Trauma

TOPLINE:

Compared with no treatment, aspirin use was associated with an increased risk for acute kidney injury (AKI) in critical patients with chest trauma, a new cohort study revealed. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and ketorolac showed no significant association with the risk for AKI.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care (MIMIC)-III dataset (2001-2012) and the MIMIC-IV dataset (2013-2019), focusing on patients admitted to the intensive care unit with chest trauma.
• The analysis included 459 patients in MIMIC-III and 364 patients in MIMIC-IV, with 34% and 41% of patients receiving NSAIDs, respectively.
• Propensity scores were used to match patients receiving NSAIDs with those not receiving treatment in a 1:2 ratio.
• Covariates included age, height, weight, body mass index, number of rib fractures, initial creatinine levels, and Sequential Organ Failure Assessment scores.
• The primary outcome was the incidence of AKI, and the secondary outcome was the incidence of AKI across different stages according to the Kidney Disease Improving Global Outcomes criteria.

TAKEAWAY:

• About 16% and 11% of patients in the MIMIC-III and MIMIC-IV datasets had AKI, respectively.
• Aspirin use was associated with an increased risk for AKI in the MIMIC-III (odds ratio [OR], 1.81; P = .04) and MIMIC-IV (OR, 2.47; P = .009) datasets.
• NSAID use was significantly associated with an elevated risk for AKI in patients aged 18-65 years (OR, 4.11; P = .016) and those who did not undergo rib surgery (OR, 1.75; P = .041).
• No significant association was found between the use of ibuprofen or ketorolac and the risk for AKI in critical patients with chest trauma.

IN PRACTICE:

“Our analysis of two datasets reveals that aspirin usage is associated with an increased risk of AKI in critical patients with chest trauma; however, no significant association was observed between the dose of aspirin and AKI,” the authors wrote. They added, “We recommend the utilization of ketorolac and ibuprofen for effective pain management in critical patients with chest trauma due to their proven efficacy without posing an increased risk of AKI development.”

SOURCE:

The study was led by Yu Huang, The Third Xiangya Hospital of Central South University, Changsha, China. It was published online on February 28, 2025, in the International Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by the analysis of data on only three NSAIDs (aspirin, ibuprofen, and ketorolac) due to exclusion criteria and propensity matching, which restricted systematic comparisons with other drugs. Additionally, both datasets lacked explicit data regarding specific types of NSAIDs despite their widespread use in pain management, potentially introducing unmeasured confounding variables. Furthermore, the single-center nature of the study may have limited the generalizability of the findings.

DISCLOSURES:

This study was funded by the National Natural Science Foundation of China. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.