Researchers identify biomarker for severe COVID-19

SAN ANTONIO — Plasminogen activator inhibitor-1, or PAI-1, may serve as a biological marker for severe COVID-19, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Susumu Fukahori, MD, PhD, of the University of South Florida, told Healio there are several possible mechanisms behind the higher risk for thrombotic arterial and venous occlusions that occur among patients with COVID-19.

“Among these mechanisms, we were interested in endothelial cell injury in COVID-19. PAI-1 is one of the major mediators produced by endothelial cells when those cells are activated by viral infection,” he said. “It is well known that the interplay of plasminogen activators and their principal inhibitor, PAI-1, plays a key role in regulating fibrinolytic activity.”

Fukahori noted that because previous clinical data suggested impaired fibrinolysis among patients with COVID-19, in addition to findings in prior studies regarding the role of PAI-1 in asthma, he and his colleagues “hypothesized that PAI-1 might also play an important role in impaired fibrinolysis in COVID-19.”

The single-center study cohort consisted of 115 adults (mean age, 60.78 years; range, 22-103; men, n = 63) who were hospitalized with confirmed COVID-19 from April to July 2020.

Researchers measured plasma PA-1 levels through the enzyme-linked immunosorbent assay, and they defined severe COVID-19 as needing a ventilator or death.

The researchers found that in addition to a significant correlation between age and PA-1 value (r = 0.271; P = .03), PA-1 levels were higher in patients with COPD and obesity (P < .01 for both).

After adjusting for age, PA-1 levels also were higher among patients on vs. not on ventilators (P = .01) and among patients who died compared with those who survived (P = .02).

Fukahori concluded that based on the findings, “we believe that high PAI-1 levels are not only a consequence of COVID-19 severity, but also a factor causing severe illness.”

He added that although information on PA-1 and its association with COVID-19 severity was only available after a patient’s infection, “genotypic information can be obtained before the person has COVID-19, so it would be very useful if the genotypic information could predict the severity of COVID-19.”

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Susumu Fukahori, MD, PhD, can be reached at susumuf@usf.edu.