Plasminogen activator inhibitor type 1 and outcome after successful cardiopulmonary resuscitation

Objective: Patients after successful cardiopulmonary resuscitation have bee n shown to exhibit elevated plasma concentrations of plasminogen activator inhibitor (PAI) type 1, the main circulating antifibrinolytic protein. It h as been suggested that elevations in PAI-1 contribute to cerebral no-reflow after successful cardiopulmonary resuscitation. We analyzed whether PAI-1 concentrations might predict cerebral outcome after cardiopulmonary resusci tation. Design: Prospective, controlled study. Setting: Intensive care unit at a university hospital. Patients: Thirty-five patients after successful cardiopulmonary resuscitati on and 35 control patients who were not critically III. Interventions. Blood sampling for determination of plasma concentrations of active and total PAI-1 antigen. Measurements and Main Results: Plasma concentrations of total and active PA I-1 antigen on the second day after successful cardiopulmonary resuscitatio n were significantly higher in patients after cardiopulmonary resuscitation than in controls (p < .0001) and were unrelated to duration of cardiopulmo nary resuscitation. Both active and total PAI-1 antigen were higher in pati ents who developed acute renal failure after cardiopulmonary resuscitation. Patients with an unfavorable cerebral outcome after cardiopulmonary resusc itation had higher total PAI-1 antigen concentrations compared with patient s with good outcome after cardiopulmonary resuscitation (p = .026). We iden tified 180 ng/mL as the best cutoff value for total PAI-1 antigen with resp ect to cerebral outcome (chi-square 11.8, p = .001). In a logistic regressi on analysis, only systemic inflammatory response syndrome (p = .028), acute renal failure after cardiopulmonary resuscitation (p = .017), and cardiopu lmonary resuscitation duration > 15 mins (p = .042) were significantly and independently associated with cerebral outcome after cardiopulmonary resusc itation. Total PAI-1 antigen reached only borderline significance (p = .058 ) but nevertheless slightly improved the correct prediction of cerebral out come after cardiopulmonary resuscitation. Conclusions. Acute renal failure after cardiopulmonary resuscitation, syste mic inflammatory response syndrome, and cardiopulmonary resuscitation durat ion are better predictors of cerebral outcome after cardiopulmonary resusci tation than PAI-1 antigen, but determination of total PAI-1 antigen neverth eless might improve the early prediction of cerebral outcome after cardiopu lmonary resuscitation. Whether elevated PAI-1 concentrations, possibly via prothrombogenic/antifibrinolytic effects, contribute causally to cerebral n o-reflow and acute renal failure after cardiopulmonary resuscitation remain s to be clarified.