Non-Infectious Causes for Elevated Procalcitonin

Area of Science:

• Biochemistry
• Clinical Medicine
• Pathophysiology

Background:

• Procalcitonin (PCT) is a biomarker often used for diagnosing bacterial infections and sepsis.
• Clinically significant PCT elevations can also arise from various non-infectious conditions.
• Understanding these non-infectious causes is crucial for accurate clinical interpretation.

Purpose of the Study:

• To systematically review human evidence on non-infectious causes of elevated procalcitonin.
• To summarize proposed pathophysiological mechanisms for non-infectious PCT elevations.
• To support context-based interpretation of PCT in clinical practice.

Main Methods:

• Systematic literature search of major biomedical databases (PubMed/MEDLINE, Embase, Web of Science, Scopus).
• Inclusion of human studies reporting quantitative PCT values in non-infectious contexts.
• Eligibility criteria included observational studies, clinical trials, and case series with at least 5 patients.

Main Results:

• Seventy-six studies were included, covering diverse conditions like systemic inflammation, cardiovascular, renal, pulmonary, gastrointestinal, autoimmune, neurologic, onco-hematologic disorders, surgery, trauma, and transplantation.
• Non-infectious PCT elevations were variable and often overlapped with ranges seen in bacterial infections.
• Significant overlap occurred in severe sterile inflammation, tissue injury (e.g., surgery, trauma, pancreatitis, burns), and certain malignancies.

Conclusions:

• Elevated procalcitonin does not definitively indicate bacterial infection.
• Clinical context, timing, and serial trends are more important than isolated thresholds for interpretation.
• Further research is needed on standardized reporting and condition-specific kinetics to refine diagnostic algorithms.