Baycan Omer Faruk, Barman Hasan Ali, Bolen Furkan, Atici Adem, Erman Hayriye, Korkmaz Rabia, Calim Muhittin, Atalay Basak, Aciksari Gonul, Cekmen Mustafa Baki, Vahaboglu Haluk, Caliskan Mustafa
Department of Cardiology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkiye.
Department of Cardiology, Istanbul University-Cerrahpasa, Institute of Cardiology, Istanbul, Turkiye.
North Clin Istanb. 2023 Feb 13;10(1):1-9. doi: 10.14744/nci.2022.09076. eCollection 2023.
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.
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.
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).
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.
新型冠状病毒肺炎（COVID-19）是一种多系统疾病，可通过加剧血栓形成、纤维蛋白溶解和炎症等症状导致严重疾病和死亡。纤溶酶原激活物抑制剂-1（PAI-1）在调节纤维蛋白溶解中起重要作用，并可能导致血栓形成事件的发生。本研究的目的是探讨PAI-1水平与COVID-19疾病严重程度及死亡率之间的关系。
共有71例住院患者通过实时聚合酶链反应检测被诊断为COVID-19。每位患者均接受了胸部计算机断层扫描（CT）。本单中心研究纳入了另外20名未感染COVID-19的志愿者的数据。在入院时收集每位患者的PAI-1数据，然后计算每位患者的CT严重程度评分（CT-SS）。
患者被分为对照组（n=20）、存活组（n=47）和非存活组（n=24）。在非存活组中，平均年龄为75.3±13.8岁，高于存活组（61.7±16.9岁）和对照组（59.5±11.2岁），（p=0.001）。当比较各组之间的PAI-1水平时，非存活组显示出最高水平，其次是存活组，然后是对照组（p<0.001）。逻辑回归分析显示，年龄、PAI-1和疾病严重程度可独立预测COVID-19死亡率。在本研究中，观察到当PAI-1水平>10.2 ng/mL用于预测COVID-19后的死亡率时，其敏感性为83%，特异性率为83%。然后，根据疾病严重程度将患者分为重症组（n=33）和非重症组（n=38）。发现重症组的PAI-1水平高于非重症组（p<0.001）。在随后的回归分析中，发现高敏肌钙蛋白I和PAI-1可指示疾病严重程度。与存活组相比，非存活组的CT-SS估计显著更高（p<0.001）。当比较重症组和非重症组之间的CT-SS时，重症组显著更高（p<0.001）。此外，CT-SS与PAI-1水平之间存在强统计学意义的正相关（r：0.838，p<0.001）。
预测与COVID-19相关的不良临床结局至关重要。本研究表明，PAI-1水平可独立预测COVID-19患者的疾病严重程度和死亡率。
