PB0040 - The Predictive Role of Plasminogen Activator Inhibitor-1 (PAI-1) in the COVID-19-associated Pneumonia

Background: PAI-1 plays a key role in a wide range of physiological and pathological processes, including coagulation, fibrinolysis, inflammation.

Aims: The aim was to estimate the prognostic role of PAI-1 on admission in hospitalized patients with confirmed COVID-19 pneumonia.

Methods: We observed 2 groups: Main – 85 patients (age – 59 (52; 65) years, men – 45 (52.9%)), hospitalized with pneumonia on the background of laboratory-confirmed (PCR) COVID-19; Control – 25 healthy volunteers (age – 50.0 (35; 65) years, men – 13 (52.0%)). General analysis, determination of PAI-1 (Human PAI-1 ELISA Kit, Elabscience) performed at admission before starting of anticoagulant treatment, autopsy data, statistical analysis.

Results: At admission the level of PAI-1 in Main group was in 60 times higher than in Control group (6.1 [0.15; 18] ng/ml versus 0.1 [0.09; 0.11] ng/ml, р=0,000). Despite the adequate treatment 12 patients died from COOVID-19 pneumonia. Maximal levels of PAI-1 were in died patients. ROC analysis shows the powerful reliable connection between increased level of PAI-1 higher than 20,6 ng/ml at admission and COVID-19 mortality (Fig.1) (OR=219; CI=95% (7,7056 to 6224,1404); p=0,0016).
Autopsy shown a lot of fibrin clots in lung vessels, which proves the theory that problem in fibrinolysis plays the crucial role in thrombogenesis in COVID-19. Fig.2 demonstrates histological section of the artery of medium caliber, branching of the pulmonary artery, in horizontal projection, a fragment of vascular endothelial integrity violation was isolated, the arrow indicates a pale pink non-nuclear mass in the form of threads – fibrin clot.

Conclusion(s): 1) problem in fibrinolysis plays the crucial role in thrombogenesis in COVID-19;
2) increased level of PAI-1 at admission more than 20 ng/l is associated with 200-times higher risk of mortality.