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

Timothy L. Tipoe; William K. K. Wu; Lilianna Chung; Mengqi Gong; Mei Dong; Tong Liu; Leonardo Roever; Jeffery Ho; Martin C. S. Wong; Matthew T. V. Chan; Gary Tse; Justin C. Y. Wu; Sunny H. Wong

doi:10.3389/fimmu.2018.01218

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

Timothy L. Tipoe
, William K. K. Wu^*
, Lilianna Chung
, Mengqi Gong
, Mei Dong
, Tong Liu
, Leonardo Roever
, Jeffery Ho
, Martin C. S. Wong
, Matthew T. V. Chan
, Gary Tse^*
, Justin C. Y. Wu^*
, Sunny H. Wong^*

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

70 Citations (Scopus)

72 Downloads (CityUHK Scholars)

Abstract

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 August 18, 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 4,467 patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were analyzed. PAI-1 levels were significantly higher in non-survivors than survivors [odds ratios (OR): 3.93, 95% confidence interval (CI): 2.31-6.67, P <0.0001] and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 95% CI: 1.37-7.75, P = 0.008).

Conclusion: 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.

Original language	English
Article number	1218
Number of pages	6
Journal	Frontiers in Immunology
Volume	9
Online published	18 Jun 2018
DOIs	https://doi.org/10.3389/fimmu.2018.01218
Publication status	Published - Jun 2018
Externally published	Yes

Funding

GT and SW are supported by clinical assistant professorships by the Croucher Foundation of Hong Kong.

Research Keywords

plasminogen activator inhibitor-1
sepsis
mortality
meta-analysis
systematic review
DISSEMINATED INTRAVASCULAR COAGULATION
ENDOTHELIAL-CELL ACTIVATION
INTENSIVE-CARE-UNIT
PROTEIN-C ACTIVITY
SEPTIC SHOCK
ORGAN DYSFUNCTION
CRITICALLY-ILL
FIBRINOLYSIS
IDENTIFICATION
POLYMORPHISMS

Publisher's Copyright Statement

This full text is made available under CC-BY 4.0. https://creativecommons.org/licenses/by/4.0/

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10.3389/fimmu.2018.01218

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Tipoe, T. L., Wu, W. K. K., Chung, L., Gong, M., Dong, M., Liu, T., Roever, L., Ho, J., Wong, M. C. S., Chan, M. T. V., Tse, G., Wu, J. C. Y., & Wong, S. H. (2018). Plasminogen Activator Inhibitor 1 for Predicting Sepsis Severity and Mortality Outcomes: A Systematic Review and Meta-Analysis. Frontiers in Immunology, 9, Article 1218. https://doi.org/10.3389/fimmu.2018.01218

@article{fd8260b079774b34939dc101d5a268df,

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

abstract = "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 August 18, 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 4,467 patients (36\% male, mean age: 62 years, mean follow-up duration: 36 days) were analyzed. PAI-1 levels were significantly higher in non-survivors than survivors [odds ratios (OR): 3.93, 95\% confidence interval (CI): 2.31-6.67, P <0.0001] and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 95\% CI: 1.37-7.75, P = 0.008). Conclusion: 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.",

keywords = "plasminogen activator inhibitor-1, sepsis, mortality, meta-analysis, systematic review, DISSEMINATED INTRAVASCULAR COAGULATION, ENDOTHELIAL-CELL ACTIVATION, INTENSIVE-CARE-UNIT, PROTEIN-C ACTIVITY, SEPTIC SHOCK, ORGAN DYSFUNCTION, CRITICALLY-ILL, FIBRINOLYSIS, IDENTIFICATION, POLYMORPHISMS",

author = "Tipoe, \{Timothy L.\} and Wu, \{William K. K.\} and Lilianna Chung and Mengqi Gong and Mei Dong and Tong Liu and Leonardo Roever and Jeffery Ho and Wong, \{Martin C. S.\} and Chan, \{Matthew T. V.\} and Gary Tse and Wu, \{Justin C. Y.\} and Wong, \{Sunny H.\}",

year = "2018",

month = jun,

doi = "10.3389/fimmu.2018.01218",

language = "English",

volume = "9",

journal = "Frontiers in Immunology",

issn = "1664-3224",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Plasminogen Activator Inhibitor 1 for Predicting Sepsis Severity and Mortality Outcomes

T2 - A Systematic Review and Meta-Analysis

AU - Tipoe, Timothy L.

AU - Wu, William K. K.

AU - Chung, Lilianna

AU - Gong, Mengqi

AU - Dong, Mei

AU - Liu, Tong

AU - Roever, Leonardo

AU - Ho, Jeffery

AU - Wong, Martin C. S.

AU - Chan, Matthew T. V.

AU - Tse, Gary

AU - Wu, Justin C. Y.

AU - Wong, Sunny H.

PY - 2018/6

Y1 - 2018/6

N2 - 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 August 18, 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 4,467 patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were analyzed. PAI-1 levels were significantly higher in non-survivors than survivors [odds ratios (OR): 3.93, 95% confidence interval (CI): 2.31-6.67, P <0.0001] and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 95% CI: 1.37-7.75, P = 0.008). Conclusion: 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.

AB - 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 August 18, 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 4,467 patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were analyzed. PAI-1 levels were significantly higher in non-survivors than survivors [odds ratios (OR): 3.93, 95% confidence interval (CI): 2.31-6.67, P <0.0001] and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 95% CI: 1.37-7.75, P = 0.008). Conclusion: 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.

KW - plasminogen activator inhibitor-1

KW - sepsis

KW - mortality

KW - meta-analysis

KW - systematic review

KW - DISSEMINATED INTRAVASCULAR COAGULATION

KW - ENDOTHELIAL-CELL ACTIVATION

KW - INTENSIVE-CARE-UNIT

KW - PROTEIN-C ACTIVITY

KW - SEPTIC SHOCK

KW - ORGAN DYSFUNCTION

KW - CRITICALLY-ILL

KW - FIBRINOLYSIS

KW - IDENTIFICATION

KW - POLYMORPHISMS

U2 - 10.3389/fimmu.2018.01218

DO - 10.3389/fimmu.2018.01218

M3 - RGC 21 - Publication in refereed journal

C2 - 29967603

SN - 1664-3224

VL - 9

JO - Frontiers in Immunology

JF - Frontiers in Immunology

M1 - 1218

ER -

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

Abstract

Funding

Research Keywords

Publisher's Copyright Statement

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