SERPINE1 and acute respiratory distress syndrome: However, when this process becomes widespread and uncontrolled, it can result in potentially devastating microangiopathy.[44] This is mainly due to the imbalance of plasminogen activator inhibitor 1 (PAI-1), which tends to be elevated in severe cases of acute respiratory distress syndrome (ARDS) associated with SARS-CoV, indicating a hypofibrinolytic state associated with the pro-state coagulant, resulting in relative hypofibrinolysis, leading to fibrin deposition in the alveoli and perialveolar capillary microthrombosis.[49] Thus, there may be a progression to ARDS.