Shielding Effects of Aspirin Use from Adverse in Hospital Outcomes in Non-Metastatic Pancreatic Cancer: An Evaluation of the National Inpatient Sample

Aspirin initially recognized for its anti-inflammatory, antipyretic and analgesic properties hold a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been studied by several groups and stratified into COX dependent and independent mechanisms. COX2 gene expression was significantly increased in colorectal cancer and various other gastrointestinal malignancies; pancreatic, esophageal and gastric cancer. Our study investigates the relationship of aspirin use and outcomes in patients with non metastatic pancreatic cancer. Methodology The Nationwide Inpatient Sample, NIS, database from 2017 to 2022 was analyzed for patients age >18 who were hospitalized for non metastatic pancreatic cancer and its decompensations using ICD-10 diagnostic codes. These patients were partitioned based on their use of aspirin. The principal outcome of this investigation is in-hospital mortality, with secondary outcomes including rates of. Multivariate logistic regression was applied to the outcomes, and the Charlson Comorbidity Index was used to adjust for confounders. A p-value (pv) of <0.05 was considered statistically significant. Results In our analysis of the NIS, 139,579 patients were identified with non-metastatic pancreatic cancer and 19,475 patients (13.9%) were identified with aspirin use and 120,177 patients (86.1%) with no aspirin use. Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio) (aOR) 0.531; p value <0.001 95% CI (confidence interval): 0.419 – 0.673. Patients with aspirin use also demonstrated significantly reduced odds of developing a pulmonary embolism, portal vein thrombosis, acute kidney injury, renal replacment therapy, septic shock, of requiring an ICU level of care. Conclusion The mortality increase in pancreatic cancer mortality, albeit alarming, serves as a driving force for treatment innovation with continual examination of current treatments and our repertoire of medications for possible repurposed applications. COX2 mediated signaling serves as a key promotor of tumorigenic molecular signaling that directly contribute to tumor cell proliferation, angiogenesis and metastasis in pancreatic cancer. Aspirin use and its inhibitory action on COX2 demonstrated a significantly reduced risk of in-hospital mortality. Aspirin use is also linked to a significant reduction in odds of developing non metastatic pancreatic cancer. Our findings support that aspirin exerts shielding effects against in-hospital mortality and protects patients with non metastatic pancreatic cancer from the development of major in hospital comorbidities as compared to those who do not use aspirin.