Usefulness of plasminogen activator inhibitor-1 as a predictive marker of mortality in sepsis

Background: Sepsis is one of the most significant causes of mortality in intensive care units. It indicates crosstalk between inflammation and coagulation. In this study, we aimed to identify prognostic markers among sepsis biomarkers and coagulation/fibrinolysis markers. Methods: Patients with sepsis according to the Sepsis-3 criteria were enrolled from January 2013 to September 2015. Univariate and multivariate logistic regression analyses were performed to identify an independent predictive marker of 28-day mortality among sepsis biomarkers and coagulation/fibrinolysis markers on ICU admission. Receiver operating characteristic analysis was performed; the optimal cutoff value of 28-day mortality was calculated using the predictive marker. Patients were classified into two groups according to the cutoff level of the predictive marker. Patient characteristics were compared between the groups. Results: A total of 186 patients were enrolled in this study; the 28-day mortality was 19.4% (36/186). PAI-1 was identified as the only independent predictive marker of 28-day mortality by univariate and multivariate logistic regression. The area under the curve was 0.72; the optimal cutoff level was 83 ng/ml (sensitivity, 75%; specificity, 61%). Patients were classified into a higher group (PAI-1 level >= 83 ng/ml; n = 85) and a lower group (PAI-1 level <83 ng/ml; n = 101). All disseminated intravascular coagulation (DIC) scores and Sequential Organ Failure Assessment score were significantly higher in the higher group than in the lower group. Conclusions: PAI-1 can predict prognosis in sepsis patients. PAI-1 reflects DIC with suppressed fibrinolysis and organ failure, with microthrombi leading to microcirculatory dysfunction.