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Elevated PAI-1 is associated with poor clinical outcomes in pediatric patients with acute lung injury

Anil Sapru1, Martha A Q Curley, Sandra Brady

  • 1Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, Box 0106, San Francisco, CA 94143, USA. anil.sapru@ucsf.edu

Intensive Care Medicine
|October 27, 2009
PubMed

Insights

Higher levels of plasminogen activator inhibitor-1 (PAI-1) are linked to increased mortality in pediatric acute lung injury (ALI). This suggests PAI-1 may be a useful prognostic biomarker for children with ALI.

Area of Science:

  • Pediatric critical care medicine
  • Pulmonology
  • Biomarkers

Background:

  • Fibrin deposition in the alveoli characterizes acute lung injury (ALI).
  • Plasminogen activator inhibitor-1 (PAI-1), an antifibrinolytic, rises during inflammation.
  • Elevated PAI-1 correlates with mortality in adult ALI, but not yet studied in children.

Purpose of the Study:

  • To investigate the association between plasma PAI-1 levels and clinical outcomes in pediatric ALI patients.
  • To determine if PAI-1 can serve as a prognostic biomarker in pediatric ALI.

Main Methods:

  • Prospective, multicenter study of 94 pediatric patients meeting ALI criteria.
  • Plasma PAI-1 levels measured on day 1 of ALI.
  • Clinical outcomes, including mortality and ventilator-free days, were tracked.

Main Results:

  • Overall mortality was 15% (14/94 patients).
  • Nonsurvivors had significantly higher plasma PAI-1 levels than survivors (P < 0.01).
  • Each log increase in PAI-1 doubled the odds of mortality, even after adjusting for age and illness severity.

Conclusions:

  • Increased PAI-1 levels are associated with higher mortality and fewer ventilator-free days in pediatric ALI.
  • Impaired fibrinolysis may contribute to ALI pathogenesis in children.
  • PAI-1 shows potential as a prognostic biomarker for pediatric ALI.
Abstract

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