Elevated PAI-1 Levels Are Associated with Severe COVID-19

A growing body of evidence points to endothelial dysfunction in severe COVID-19 cases. Plasminogen activator inhibitor-1 (PAI-1) is a marker of endothelial injury and correlates with severe uncontrolled asthma. PAI-1 could be a candidate as a prognostic marker of COVID-19-related hospitalization and clinical outcomes. Therefore, the association between PAI-1 and the severity of COVID-19 was investigated. This is a single-center retrospective study of a cohort of 115 hospitalized adult patients from April to July 2020 with confirmed COVID-19. Plasma PAI-1 levels were measured by ELISA. The primary endpoint was the difference in PAI-1 levels between the severe COVID-19 and the non-severe COVID-19 groups. Severe COVID-19 was defined as requiring ventilator management and/or death. The mean age was 60.78 (22 to 103, SD ± 16.93), and 52 were female and 63 male. There was a significant correlation between age and PAI-1 value. (r=0.271, p=0.03). PAI-1 levels were significantly higher in patients with both COPD (p<0.01) and obesity (p<0.01). PAI-1 levels of patients who were on a ventilator were significantly higher than those who were not (adjusted for age; p=0.01). Also, PAI-1 levels of patients who died were significantly higher than those who survived (adjusted for age; p=0.02). High plasma PAI-1 levels were associated with severe COVID-19 infections defined as requiring ventilator management and/or death. PAI-1 could be a biologic marker for severe COVID-19.