Background: Disseminated intravascular coagulation (DIC) is a critical complication in neonatal infections, necessitating early detection to reduce mortality. This study investigates the clinical utility of the tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) in assessing infection-induced neonatal DIC.
Methods: A retrospective analysis of 61 neonates with infections (July 2021-February 2023) at West China Second University Hospital categorized patients into DIC (n = 23) and non-DIC (n = 38) groups using the Chinese DIC scoring system (CDSS). Univariate, multivariate, ROC, and Kaplan-Meier analyses evaluated t-PAIC levels, and a nomogram model was developed. A prospective study (March 2023-January 2024) with 53 neonates validated the t-PAIC threshold for DIC prediction.
Results: t-PAIC (OR = 1.332, p = 0.045), thrombin time (TT) (OR = 2.317, p = 0.014), and aspartate aminotransferase (AST) (OR = 1.008, p = 0.014) were independent DIC risk factors. t-PAIC predicted DIC with an AUC of 0.783 (p = 0.000), sensitivity of 0.652, and specificity of 0.816. A t-PAIC threshold ≥ 8.85 ng/mL increased DIC risk and mortality (HR = 3.434, p = 0.01). The nomogram combining t-PAIC, TT, and AST showed superior predictive performance (AUC = 0.896, sensitivity = 0.826, specificity = 0.842). The prospective study confirmed t-PAIC ≥ 8.85 ng/mL as a predictive marker for DIC (p < 0.05).
Conclusion: t-PAIC is an independent DIC risk factor in neonates with infections. A t-PAIC level ≥ 8.85 ng/mL significantly increases DIC risk and mortality, highlighting its clinical utility in assessing infection-induced neonatal DIC.
Keywords: coagulation; disseminated intravascular coagulation; infection; neonate; tissue‐type plasminogen activator‐plasminogen activator inhibitor‐1 complex.
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