Plasminogen activator inhibitor 1 promotes a poor prognosis in sepsis-induced disseminated intravascular coagulation

• Published in: International journal of hematology Vol. 84; no. 5; pp. 398 - 405
• Main Authors: MADOIWA, Seiji, NUNOMIYA, Shin, ONO, Tomoko, SHINTANI, Yuichi, OHMORI, Tsukasa, MIMURO, Jun, SAKATA, Yoichi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer 01.12.2006; Springer Nature B.V
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Diagnosis, Differential; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - complications; Disseminated Intravascular Coagulation - diagnosis; Disseminated Intravascular Coagulation - mortality; Female; Fibrin Fibrinogen Degradation Products - analysis; Hematologic and hematopoietic diseases; Humans; Male; Medical sciences; Middle Aged; Multiple Organ Failure - blood; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Plasminogen Activator Inhibitor 1 - blood; Platelet diseases and coagulopathies; Prognosis; Sepsis - blood; Sepsis - complications; Sepsis - diagnosis; Sepsis - mortality; Survival Rate; Infection; Sepsis syndrome; Plasminogen activator inhibitor 1; Disseminated intravascular coagulopathy; Prognosis; Hematology; Multiple organ failure; Disseminated intravascular coagulation; Sepsis; Hemopathy; Coagulopathy
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1532/ijh97.05190

Sepsis-induced disseminated intravascular coagulation (DIC) is a serious condition because it is closely linked to the development of multiple organ dysfunctions. We compared molecular fibrinolysis markers for 117 patients with sepsis-induced DIC and 1627 patients with nonseptic DIC. Levels of fibrinogen and fibrin degradation products and D-dimer were significantly lower in sepsis-induced DIC cases than in nonseptic DIC cases. In septic DIC cases, plasma plasminogen activator inhibitor 1 (PAI-1) levels were significantly higher than in nonseptic DIC cases. D-dimer levels were negatively correlated with plasma PAI-1 levels in septic DIC cases. Multiple Organ Dysfunction Scores were significantly higher in septic DIC patients with PAI-1 levels >90 ng/mL than in the group with PAI-1 levels <30 ng/mL. The Kaplan-Meier survival functions until 28 days after DIC diagnosis were significantly lower in the group with PAI-1 levels >90 ng/mL than in the other groups. In a multivariate analysis, plasma PAI-1 levels at DIC diagnosis were an independent risk factor for mortality in sepsis-induced DIC (hazard ratio, 1.012; P = .008). These data suggest that plasma PAI-1 plays an important role in sustaining DIC in septic DIC cases and contributes to multiple organ failure and decreased survival in such patients.