Does pulmonary embolism (PE) elevate procalcitonin levels?

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Last updated: March 23, 2025 • View editorial policy

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From the Guidelines

Pulmonary embolism (PE) typically does not significantly elevate procalcitonin levels, as procalcitonin is primarily a marker for bacterial infections, particularly sepsis, and remains relatively normal in non-infectious inflammatory conditions like PE. The most recent and highest quality study, 1, which included 598 patients, found that the measurement of procalcitonin concentrations added no relevant additional diagnostic information over symptoms and signs in patients with suspected pneumonia or influenza. This suggests that procalcitonin levels are not significantly elevated in non-infectious conditions, including PE.

Key Points

  • Procalcitonin is a marker for bacterial infections, particularly sepsis, and remains relatively normal in non-infectious inflammatory conditions like PE.
  • Some studies have shown minor elevations in procalcitonin with PE (usually below 0.5 ng/mL), but these levels are substantially lower than those seen in bacterial infections (often >2 ng/mL).
  • The distinction between PE and pneumonia, which can present with similar symptoms, can be clinically useful when differentiating between the two conditions.
  • If a patient with suspected PE has markedly elevated procalcitonin levels (>2 ng/mL), clinicians should consider concurrent bacterial infection as a possibility.

Clinical Implications

The fact that PE does not significantly elevate procalcitonin levels has important clinical implications. Clinicians can use procalcitonin levels to help differentiate between PE and pneumonia, and to identify patients who may have a concurrent bacterial infection. However, it is essential to note that procalcitonin levels should be interpreted in the context of the patient's overall clinical presentation and other diagnostic test results.

Evidence Summary

The evidence from the studies 1 suggests that procalcitonin levels are not significantly elevated in patients with PE. While some studies have shown minor elevations in procalcitonin with PE, these levels are substantially lower than those seen in bacterial infections. The most recent and highest quality study, 1, found that the measurement of procalcitonin concentrations added no relevant additional diagnostic information over symptoms and signs in patients with suspected pneumonia or influenza.

From the Research

Pulmonary Embolism and Procalcitonin Levels

  • Pulmonary embolism (PE) is a condition where one or more arteries in the lungs become blocked by a blood clot 2.
  • The relationship between PE and procalcitonin levels is not fully understood, but some studies suggest that procalcitonin may be elevated in patients with PE, particularly in those with concomitant infections 3.
  • A study published in 2016 found that procalcitonin levels were higher in patients with community-acquired pneumonia (CAP) compared to those with PE, suggesting that procalcitonin may not be a reliable marker for diagnosing PE 4.
  • However, another study published in 2023 found that elevated procalcitonin levels (> 0.25 µg/L) were associated with an increased risk of adverse outcomes in patients with acute PE, independent of other risk factors 3.
  • It is essential to note that procalcitonin is a non-specific marker of infection and inflammation, and its elevation can be seen in various conditions, including bacterial pneumonia and acute eosinophilic pneumonia 5.

Key Findings

  • Elevated procalcitonin levels have been observed in patients with acute PE, particularly in those with concomitant infections 3.
  • Procalcitonin may not be a reliable marker for diagnosing PE, as its levels can be influenced by various factors, including infections and inflammation 4.
  • Further research is needed to fully understand the relationship between PE and procalcitonin levels, and to determine the clinical utility of procalcitonin as a biomarker in patients with PE 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?

Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2016

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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