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Sustained high plasma plasminogen activator inhibitor-1 levels are associated with severity and mortality in septic patients.

AbstractBACKGROUND:
Higher plasma plasminogen activator inhibitor-1 (PAI-1) levels have been reported in septic patients. However, some questions remain unanswered, such as whether there is an association between plasma PAI-1 levels and sepsis severity and mortality, and inflammation state during the first week.
METHODS:
Multicenter, observational and prospective study carried out in six Spanish Intensive Care Units of 260 patients with severe sepsis. Circulating levels of PAI-1 and tumour necrosis factor (TNF)-α were measured at day 1, 4 and 8. End-point was 30-day mortality.
RESULTS:
Nonsurviving septic patients (n=89) presented higher PAI-1 levels than surviving (n=171) at day 1 (58.4 (33.3-83.8) vs 36.5 (21.1-62.5) ng/mL; p<0.001), 4 (34.0 (14.7-53.3) vs 16.2 (10.2-27.4) ng/mL; p<0.001) and 8 (30.6 (16.2-47.8) vs 18.9 (10.4-29.5) ng/mL; p=0.004). We found a positive correlation of PAI-1 levels with SOFA, lactic acid, aPTT, INR and TNF-α, and negative with platelet count at day 1, 4 and 8. Logistic regression analyses showed that PAI-1 levels at day 1 (p<0.001), 4 (p<0.001) and 8 (p=0.001) were associated with 30-day mortality. On ROC curve analysis to predict 30- day survival, the area under the curve of PAI-1 levels at day 1, 4 and 8 were 0.65 (95% CI=0.58-0.72; p<0.001), 0.69 (95% CI=0.60-0.78; p<0.001) and 0.65 (95% CI=0.54-0.75; p=0.005) respectively.
CONCLUSIONS:
The most interesting findings of our study, to our knowledge the largest series reporting PAI-1 levels during follow-up in septic patients, were that plasma PAI-1 levels during the first week were associated with inflammation, severity and mortality.
AuthorsLeonardo Lorente, María M Martín, Juan M Borreguero-León, Jordi Solé-Violán, José Ferreres, Lorenzo Labarta, César Díaz, Alejandro Jiménez, José A Páramo
JournalThrombosis research (Thromb Res) Vol. 134 Issue 1 Pg. 182-6 (Jul 2014) ISSN: 1879-2472 [Electronic] United States
PMID24814968 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 Elsevier Ltd. All rights reserved.
Chemical References
  • Biomarkers
  • Plasminogen Activator Inhibitor 1
Topics
  • Aged
  • Biomarkers (blood)
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plasminogen Activator Inhibitor 1 (blood)
  • Prognosis
  • Prospective Studies
  • Sepsis (blood)
  • Survival Rate
  • Treatment Outcome

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