Background: Sepsis is an unorganized host response to infection that is manifested by the failure of organs and DIC and systemic coagulation due to failure of Plasmin as an important fibrin lytic protein that is regulated by plasminogen activators and inhibitors. Our theory is that elevated PAI-1 may have a role in multi-system organ failure in patients with septicemia and systemic coagulopathy. Aim: to evaluate plasminogen activator inhibitor-1 as a prognostic factor in patients with septicemia and DIC. Patients and Methods: 60 cases with septicemia and in shock, in addition to 20 healthy individuals. Cases were selected from surgical ICU, Tanta University hospitals. Normal healthy subjects were matched by age and gender with the patients' group. Results: Respiratory system and urinary tract infections, were the most common infections and high SOFA and APACHE scores in the selected cases. The hematological findings in septic patients are anemia, thrombocytopenia, and leukocytosis. There was a significant increase in urea, creatinine, SGOT, SGPT levels, and CRP in patient groups. Higher levels of PAI-1 in cases suffering sepsis. An increased mortality rate after 28 days of follow-up was noticeable in cases with established septic shock compared to other patient groups in Tanta university surgical intensive care. We found a direct correlation between PAI-1and SOFA, APACHE, bilirubin, creatinine, PT, APTT, and Procalcitonin. Conclusions: PAI-1 level has a prognostic value in cases with infections or septicemia presented to our emergency center.