Alveolar plasminogen activator inhibitor-1 predicts ARDS in aspiration pneumonitis

Intensive Care Med. 2006 Jan;32(1):110-5. doi: 10.1007/s00134-005-2847-2. Epub 2005 Nov 12.


Objective: To test the hypothesis that alveolar plasminogen activator inhibitor-1 (PAI-1) can identify patients with witnessed aspiration at risk for progression to acute respiratory distress syndrome (ARDS).

Design: Prospective observational study.

Setting: Medical intensive care unit in a tertiary care center.

Patients: Fifty-one patients with witnessed aspiration who had a PaO2/FIO2<300 for a period no less than 4 h from admission.

Interventions: Alveolar fluid sampling was performed within 8 h of intubation via luminal suction of the distal airways using a 13-Fr catheter. Plasma levels were collected simultaneously by venipuncture.

Measurements and results: Alveolar PAI-1 antigen levels were more than five times higher in those who progressed to ARDS than in those with uncomplicated aspiration pneumonitis (2687+/-1498 ng/ml vs. 587+/-535 ng/ml, respectively; p<0.001), while plasma levels of PAI-1 antigen were not significantly different between the two groups. The measured activity of PAI-1 antigen paralleled the levels observed in both media. A cut-off level of alveolar PAI-1 >1518 ng/ml was found to be 82.4% (56.6%-96.0%) sensitive and 97.1% (84.6%-99.5%) specific in predicting progression to ARDS. There was also a significant inverse relationship between elevation of PAI-1 antigen levels and the degree of lung injury as assessed by the days of unassisted ventilation (r2=0.37; p<0.001).

Conclusions: Elevation of alveolar PAI-1 antigen levels postaspiration is the consequence of local rather than systemic activation of the fibrinolytic system. Measurement of alveolar PAI-1 antigen levels can be a useful clinical marker in predicting progression to ARDS after gastric aspiration.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Male
  • Plasminogen Activator Inhibitor 1 / immunology
  • Plasminogen Activator Inhibitor 1 / metabolism*
  • Pneumonia, Aspiration / diagnosis*
  • Pneumonia, Aspiration / metabolism
  • Prospective Studies
  • Pulmonary Alveoli / metabolism*
  • ROC Curve
  • Respiratory Distress Syndrome / prevention & control*
  • Sensitivity and Specificity


  • Biomarkers
  • Plasminogen Activator Inhibitor 1