Plasminogen activator inhibitor-1 levels as an indicator of severity and mortality for COVID-19

Omer Faruk Baycan; Hasan Ali Barman; Furkan Bolen; Adem Atici; Hayriye Erman; Rabia Korkmaz; Muhittin Calim; Basak Atalay; Gonul Aciksari; Mustafa Baki Cekmen; Haluk Vahaboglu; Mustafa Caliskan

doi:10.14744/nci.2022.09076

Plasminogen activator inhibitor-1 levels as an indicator of severity and mortality for COVID-19

North Clin Istanb. 2023 Feb 13;10(1):1-9. doi: 10.14744/nci.2022.09076. eCollection 2023.

Authors

Affiliations

¹ Department of Cardiology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.
² Department of Cardiology, Istanbul University-Cerrahpasa, Institute of Cardiology, Istanbul, Turkiye.
³ Department of Biochemistry, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.
⁴ Department of Anesthesiology and Reanimation, Bezmialem Vakif University, Istanbul, Turkiye.
⁵ Department of Radiology, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.
⁶ Department of Infection Disease, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.

Abstract

Objective: Coronavirus disease-19 (COVID-19) is a multisystemic disease that can cause severe illness and mortality by exacerbating symptoms such as thrombosis, fibrinolysis, and inflammation. Plasminogen activator inhibitor-1 (PAI-1) plays an important role in regulating fibrinolysis and may cause thrombotic events to develop. The goal of this study is to examine the relationship between PAI-1 levels and disease severity and mortality in relation to COVID-19.

Methods: A total of 71 hospitalized patients were diagnosed with COVID-19 using real time-polymerase chain reaction tests. Each patient underwent chest computerized tomography (CT). Data from an additional 20 volunteers without COVID-19 were included in this single-center study. Each patient's PAI-1 data were collected at admission, and the CT severity score (CT-SS) was then calculated for each patient.

Results: The patients were categorized into the control group (n=20), the survivor group (n=47), and the non-survivor group (n=24). In the non-survivor group, the mean age was 75.3±13.8, which is higher than in the survivor group (61.7±16.9) and in the control group (59.5±11.2), (p=0.001). When the PAI-1 levels were compared between each group, the non-survivor group showed the highest levels, followed by the survivor group and then the control group (p<0.001). Logistic regression analysis revealed that age, PAI-1, and disease severity independently predicted COVID-19 mortality rates. In this study, it was observed that PAI-1 levels with >10.2 ng/mL had 83% sensitivity and an 83% specificity rate when used to predict mortality after COVID-19. Then, patients were divided into severe (n=33) and non-severe (n=38) groups according to disease severity levels. The PAI-1 levels found were higher in the severe group (p<0.001) than in the non-severe group. In the regression analysis that followed, high sensitive troponin I and PAI-1 were found to indicate disease severity levels. The CT-SS was estimated as significantly higher in the non-survivor group compared to the survivor group (p<0.001). When comparing CT-SS between the severe group and the non-severe group, this was significantly higher in the severe group (p<0.001). In addition, a strong statistically significant positive correlation was found between CT-SS and PAI-1 levels (r: 0.838, p<0.001).

Conclusion: Anticipating poor clinical outcomes in relation to COVID-19 is crucial. This study showed that PAI-1 levels could independently predict disease severity and mortality rates for patients with COVID-19.

Keywords: Coronavirus disease-19; disease severity; mortality; plasminogen activator inhibitor-1; thromboembolism.