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

Objectives: Plasminogen 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. Methods: PubMed and Embase were searched until 18th August 2017 for studies that evaluated the relationships between PAI-1 levels and disease severity or mortality in sepsis. Results: A 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 4467 patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were analysed. PAI-1 levels were significantly higher in non-survivors than survivors (odds ratio [OR]: 3.93, 95% confidence interval: 2.31 to 6.67, P < 0.0001) and in patients with severe sepsis than in those less severe sepsis (odds ratio [OR]: 3.26, 95% confidence interval: 1.37 to 7.75, P = 0.008). Conclusions: PAI-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.