Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 11:5:42.
doi: 10.1186/s40560-017-0238-8. eCollection 2017.

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

Kota Hoshino  1 , Taisuke Kitamura  1 , Yoshihiko Nakamura  1 , Yuhei Irie  1 , Norihiko Matsumoto  1 , Yasumasa Kawano  1 , Hiroyasu Ishikura  1
Affiliations

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

Kota Hoshino et al. J Intensive Care. .

Abstract

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.

Keywords: Disseminated intravascular coagulation; Fibrinolysis; Pathogen-associated molecular patterns; Sepsis-3.

PubMed Disclaimer

Conflict of interest statement

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart. Flow diagram of patients who met the inclusion/exclusion criteria for the study population
Fig. 2
Fig. 2
Kaplan–Meier analysis. The survival rate is significantly higher in the higher group (PAI-1 level ≥83 ng/ml; n = 85) than that in the lower group (PAI-1 level <83 ng/ml; n = 101) (log-rank test, P < 0.01)
Fig. 3
Fig. 3
Time courses of sepsis biomarker and coagulation/fibrinolysis marker levels. This figure shows time course (days 0, 3, and 7) of PSEP, TAT, PC, SF, and PAI-1 levels that were significantly different according to univariate analyses. †P < 0.05, ††P < 0.01 according to Mann–Whitney U test
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9. doi: 10.1001/jama.2009.1754. - DOI - PubMed
    1. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53. doi: 10.1097/01.CCM.0000194725.48928.3A. - DOI - PubMed
    1. Wittebole X, Castanares-Zapatero D, Laterre PF. Toll-like receptor 4 modulation as a strategy to treat sepsis. Mediators Inflamm. 2010;2010:568396. doi: 10.1155/2010/568396. - DOI - PMC - PubMed
    1. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. 2012;18:891–7. doi: 10.1007/s10156-012-0435-2. - DOI - PubMed
    1. Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother. 2011;17:764–9. doi: 10.1007/s10156-011-0254-x. - DOI - PubMed

LinkOut - more resources

-