From the Guidelines
Procalcitonin can be elevated due to several non-infectious causes, including severe acute pancreatitis, as evidenced by the 2019 WSES guidelines for the management of severe acute pancreatitis 1.
Non-Infectious Causes of Elevated Procalcitonin
Some of the major non-infectious causes include:
- Major trauma, surgery, burns, and cardiogenic shock, where tissue damage triggers inflammatory responses similar to those seen in infections
- Certain malignancies, particularly medullary thyroid carcinoma and small cell lung cancer, can directly produce procalcitonin
- Acute kidney injury and end-stage renal disease may lead to elevated levels due to decreased clearance
- Autoimmune conditions like vasculitis and systemic lupus erythematosus can cause elevations through inflammatory pathways
- Newborns naturally have higher procalcitonin levels in the first 48 hours of life
- Severe systemic inflammation from conditions like pancreatitis or heatstroke can increase levels through pro-inflammatory cytokine release
- Certain medications including alemtuzumab, anti-thymocyte globulin, and granulocyte colony-stimulating factors may also raise procalcitonin These non-infectious elevations occur because procalcitonin is not only produced during bacterial infections but also released during severe systemic stress and inflammation when cytokines like TNF-α, IL-1β, and IL-6 stimulate extrathyroidal tissues to produce procalcitonin.
Clinical Implications
In clinical practice, it is essential to consider these non-infectious causes of elevated procalcitonin, as they can have significant implications for patient management, particularly in the context of severe acute pancreatitis, as highlighted in the 2019 WSES guidelines 1. Additionally, the use of procalcitonin as a diagnostic tool has been explored in other contexts, such as anorectal emergencies 1 and COVID-19 1, further emphasizing the importance of considering non-infectious causes of elevated procalcitonin.
From the Research
Non-Infectious Causes of Elevated Procalcitonin
- Procalcitonin (PCT) is a serum biomarker that can be elevated in response to various conditions, not just infections 2, 3.
- Surgery and trauma alone can elevate PCT levels, even in the absence of infection 2.
- Medullary thyroid cancer metastases can produce PCT, leading to elevated levels in the absence of infection 3.
- Other non-infectious causes of inflammation, such as drug-related or tumor-associated fever, can also affect PCT levels 4.
Conditions that Can Elevate Procalcitonin
- Trauma 2, 5
- Surgery 2
- Medullary thyroid cancer metastases 3
- Non-infectious inflammation, such as drug-related or tumor-associated fever 4
- Critical illness, which can lead to changes in metabolomic response and energy utilization pathways 6