OBJECTIVES: Plasminogen activator inhibitor-1 (PAI-1), a crucial regulator of 
fibrinolysis, is increased in sepsis, but its values in predicting disease 
severity or mortality outcomes have been controversial. Therefore, we conducted 
a systematic review and meta-analysis of its predictive values in sepsis.
METHODS: PubMed and Embase were searched until August 18, 2017 for studies that 
evaluated the relationships between PAI-1 levels and disease severity or 
mortality in sepsis.
RESULTS: A total of 112 and 251 entries were retrieved from the databases, of 
which 18 studies were included in the final meta-analysis. A total of 4,467 
patients (36% male, mean age: 62 years, mean follow-up duration: 36 days) were 
analyzed. PAI-1 levels were significantly higher in non-survivors than survivors 
[odds ratios (OR): 3.93, 95% confidence interval (CI): 2.31-6.67, P < 0.0001] 
and in patients with severe sepsis than in those less severe sepsis (OR: 3.26, 
95% CI: 1.37-7.75, P = 0.008).
CONCLUSION: PAI-1 is a significant predictor of disease severity and all-cause 
mortality in sepsis. Although the predictive values of PAI-1 reached statistical 
significance, the clinical utility of PAI-1 in predicting outcomes will require 
carefully designed prospective trials.