The association between plasminogen activator inhibitor type-1 and clinical outcome in paediatric sepsis

Area of Science:

• Pediatric critical care medicine
• Hematology
• Infectious diseases

Background:

• Plasminogen activator inhibitor type-1 (PAI-1) is an acute phase protein crucial for inhibiting fibrinolysis.
• Elevated PAI-1 levels are associated with poorer outcomes in sepsis and sepsis-induced disseminated intravascular coagulation (DIC).
• Understanding PAI-1 dynamics in pediatric sepsis is vital for predicting clinical outcomes.

Purpose of the Study:

• To investigate the relationship between plasma PAI-1 levels and clinical outcomes in children diagnosed with sepsis.
• To analyze PAI-1 level changes over time in relation to DIC status and survival.

Main Methods:

• A prospective study involving 35 children with sepsis.
• Plasma PAI-1 levels were measured on day 1 and day 4 of admission.
• Coagulation profiles were assessed on day 4, and patients were followed for 28 days for survival outcomes.

Main Results:

• PAI-1 levels significantly decreased from day 1 to day 4 in non-overt DIC patients (95.25 ± 46.57 vs. 60.36 ± 37.31 ng/ml, P ≤ 0.001).
• Survivors showed a statistically significant decrease in PAI-1 from day 1 to day 4 (82.47 ± 44.43 vs. 58.39 ± 32.98 ng/ml, P = 0.021).
• No significant PAI-1 level changes were observed between day 1 and day 4 in overt DIC patients or non-survivors. PAI-1 positively correlated with DIC score (r = 0.606, P ≤ 0.001).

Conclusions:

• PAI-1 levels decrease over time in pediatric sepsis survivors, particularly those without overt DIC.
• The lack of significant PAI-1 reduction in overt DIC and non-survivors suggests a different pathophysiological role in severe sepsis.
• PAI-1 levels and their dynamic changes may serve as potential biomarkers for sepsis severity and outcome prediction in children.