Plasminogen Activator Inhibitor 1 for Predicting Sepsis Severity and Mortality Outcomes: A Systematic Review and Meta-Analysis

• Main Authors: Timothy L. Tipoe, William K. K. Wu, Lilianna Chung, Mengqi Gong, Mei Dong, Tong Liu, Leonardo Roever, Jeffery Ho, Martin C. S. Wong, Matthew T. V. Chan, Gary Tse, Justin C. Y. Wu, Sunny H. Wong
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2018-06-01
• Series: Frontiers in Immunology
• Subjects: plasminogen activator inhibitor-1; sepsis; mortality; meta-analysis; systematic review
• Online Access: https://www.frontiersin.org/article/10.3389/fimmu.2018.01218/full

ObjectivesPlasminogen activator inhibitor-1 (PAI-1), a crucial regulator of fibrinolysis, is increased in sepsis, but its values in predicting disease severity or mortality outcomes have been controversial. Therefore, we conducted a systematic review and meta-analysis of its predictive values in sepsis.MethodsPubMed and Embase were searched until August 18, 2017 for studies that evaluated the relationships between PAI-1 levels and disease severity or mortality in sepsis.ResultsA total of 112 and 251 entries were retrieved from the databases, of which 18 studies were included in the final meta-analysis. A total of 4,467 patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were analyzed. PAI-1 levels were significantly higher in non-survivors than survivors [odds ratios (OR): 3.93, 95% confidence interval (CI): 2.31–6.67, P < 0.0001] and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 95% CI: 1.37–7.75, P = 0.008).ConclusionPAI-1 is a significant predictor of disease severity and all-cause mortality in sepsis. Although the predictive values of PAI-1 reached statistical significance, the clinical utility of PAI-1 in predicting outcomes will require carefully designed prospective trials.