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Intensive Care Medicine

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Open Access 01-01-2010 | Experimental

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

Authors: Anil Sapru, Martha A. Q. Curley, Sandra Brady, Michael A. Matthay, Heidi Flori

Published in: Intensive Care Medicine | Issue 1/2010

Abstract

Purpose

Deposition of fibrin in the alveolar space is a hallmark of acute lung injury (ALI). Plasminogen activator inhibitor-1 (PAI-1) is an antifibrinolytic agent that is activated during inflammation. Increased plasma and pulmonary edema fluid levels of PAI-1 are associated with increased mortality in adults with ALI. This relationship has not been examined in children. The objective of this study was to test whether increased plasma PAI-1 levels are associated with worse clinical outcomes in pediatric patients with ALI.

Design/methods

We measured plasma PAI-1 levels on the first day of ALI among 94 pediatric patients enrolled in two separate prospective, multicenter investigations and followed them for clinical outcomes. All patients met American European Consensus Conference criteria for ALI.

Results

A total of 94 patients were included. The median age was 3.2 years (range 16 days–18 years), the PaO₂/F_iO₂ was 141 ± 72 (mean ± SD), and overall mortality was 14/94 (15%). PAI-1 levels were significantly higher in nonsurvivors compared to survivors (P < 0.01). The adjusted odds of mortality doubled for every log increase in the level of plasma PAI-1 after adjustment for age and severity of illness.

Conclusions

Higher PAI-1 levels are associated with increased mortality and fewer ventilator-free days among pediatric patients with ALI. These findings suggest that impaired fibrinolysis may play a role in the pathogenesis of ALI in pediatric patients and suggest that PAI-1 may serve as a useful biomarker of prognosis in patients with ALI.

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Title: Elevated PAI-1 is associated with poor clinical outcomes in pediatric patients with acute lung injury
Authors: Anil Sapru
Martha A. Q. Curley
Sandra Brady
Michael A. Matthay
Heidi Flori
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1690-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Design/methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Design/methods

Results

Conclusions

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