Procalcitonin in Acute Pancreatitis: Diagnostic Utility for Differentiating Infected from Sterile Pancreatic Necrosis

Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas that disrupts its normal function and often requires hospitalization because of severe abdominal pain. While most patients recover without major complications, some develop pancreatic necrosis, infected pancreatic necrosis (IPN), persistent organ failure, and other severe complications associated with increased morbidity and mortality. A key clinical challenge is distinguishing infected pancreatic necrosis from sterile pancreatic inflammation, as delayed or inaccurate diagnosis may result in inappropriate antibiotic use and poorer clinical outcomes. This review aimed to evaluate the diagnostic and prognostic utility of procalcitonin (PCT) in differentiating infected pancreatic necrosis from sterile inflammation and to assess its role in supporting antimicrobial decision-making in patients with AP. A structured narrative literature review was conducted using PubMed, Embase, Scopus, and Web of Science to identify English-language human studies, meta-analyses, randomized controlled trials, and international guidelines published between January 2000 and December 2025. A total of 60 studies were included in the narrative synthesis. The reviewed evidence indicates that PCT may provide greater diagnostic specificity for bacterial infection than conventional inflammatory markers such as C-reactive protein (CRP) and leukocyte count in selected clinical settings. Elevated or persistently increasing PCT concentrations have been associated with IPN, sepsis, organ failure, and increased mortality. Furthermore, PCT-guided antibiotic stewardship strategies may reduce unnecessary antibiotic exposure without adversely affecting clinical outcomes in selected settings. Overall, PCT represents a potentially valuable adjunctive biomarker for differentiating IPN from sterile inflammation in patients with AP. When interpreted alongside clinical assessment and imaging findings, PCT may facilitate the assessment of infection risk, prognostic stratification, and antimicrobial stewardship. However, further large-scale prospective multicenter studies are warranted to establish standardized diagnostic thresholds and optimize its integration into routine clinical practice.