Validating plasminogen activator inhibitor-1 as a poor prognostic factor in sepsis

Aim: Our previous report indicated that plasminogen activator inhibitor-1 (PAI-1) levels of >= 83 ng/mL in patients with sepsis tended to be associated with disseminated intravascular coagulation (DIC), suppressed fibrinolysis, multiple organ dysfunction, and mortality. Therefore, the present study aimed to validate whether 83 ng/mL was a useful cut-off value for using PAI-1 levels to predict a poor prognosis in sepsis. Methods: Patients with sepsis were included in this single-center retrospective study. The patients were classified as having high or low PAI-1 values (<83 ng/mL versus >= 83 ng/mL), and were compared in terms of their pre-DIC state, intensive care unit-free days, continuous renal replacement therapy-free days, ventilator-free days, catecholamine-free days, and 28-day survival rate. Results: The high PAI-1 group included 61 patients (54%) and the low PAI-1 group included 52 patients (46%). The high PAI-1 group had significantly higher frequencies of a pre-DIC state within 1 week (P = 0.009). There was no significant difference in ventilator-free days. However, the high PAI-1 group had significantly lower values for intensive care unit-free days (P = 0.01), continuous renal replacement therapy-free days (P = 0.02), and catecholamine-free days (P = 0.02). The high PAI-1 group also had a significantly lower 28-day survival rate based on the Kaplan-Meier analysis (log-rank, P = 0.03). Conclusion: Patients with sepsis and PAI-1 levels of >= 83 ng/mL had elevated risks of coagulopathy, organ failure, and mortality. Thus, these results suggest that 83 ng/mL could be a useful cut-off value for prognostication based on PAI-1 levels in this setting.