Background: Liver cirrhosis not only leads to high mortality but also imposes significant economic burdens and health losses. Aspirin is a drug with potential indications for liver disease, but its benefits in cirrhosis have primarily been demonstrated in outpatient settings. This study aimed to determine whether aspirin therapy confers protective effects on the prognosis of critically ill cirrhosis patients.
Methods: Cirrhosis patients were identified from the Medical Information Mart for Critical Care Medicine IV (MIMIC-IV) database. Propensity score matching (PSM) was used to balance baseline differences. Multivariate Cox regression models assessed the association between aspirin therapy and 30-day and 90-day mortality, while multivariable logistic regression models evaluated its relationship with in-hospital mortality. Due to a lack of relevant data, this study could not assess aspirin-related bleeding events.
Results: The study included 3,105 patients, of whom 348 received aspirin and 2,757 did not. After propensity score matching, 334 matched pairs were successfully identified. The 30-day mortality rate among aspirin users was 15.27%, and the 90-day mortality rate was 16.77%, both lower than those among non-users. Multivariate Cox regression analysis demonstrated that aspirin use was associated with reduced 30-day mortality (HR 0.69, 95% CI 0.48–0.99) and 90-day mortality (HR 0.65, 95% CI 0.46–0.92). Multivariable logistic regression analysis indicated that aspirin use was associated with reduced in-hospital mortality (OR = 0.66, 95% CI 0.44–0.99). There was no significant difference in intensive care unit length of stay between the two groups. However, due to most participants (81.0%) receiving the 81 mg/d dose, the significant disparity in sample sizes between the high- and low-dose groups and the baseline imbalance precluded reliable dose-response comparisons in this study.
Conclusion: This single-Centre retrospective study found that aspirin use was associated with reduced mortality in critically ill patients with liver cirrhosis. However, the overall net therapeutic effect remains to be further validated due to the lack of data on bleeding risk. The relationship between aspirin dosage and specific outcomes requires clarification in future studies with larger sample sizes and more prospective designs.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12876-025-04499-2.
Keywords: Aspirin; Intensive care unit; Liver cirrhosis; MIMIC-IV database; Mortality.