title: Plasminogen activator inhibitor 1 promotes a poor prognosis in sepsis-induced disseminated intravascular coagulation.
abstract: 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.
authors.affiliation: Research Division of Cell and Molecular Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Madoiwa
authors.forename: Shin
authors.initials: S
authors.lastname: Nunomiya
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ono
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shintani
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ohmori
authors.forename: Jun
authors.initials: J
authors.lastname: Mimuro
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sakata
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000401:mortality; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D011379:Prognosis; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D