Procalcitonin elevation in acetaminophen intoxication without bacterial infection

Han, Seung Baik; Durey, Areum; Lee, Yu Jin; Kim, Ji Hye

J Korean Soc Emerg Med > Volume 36(5); 2025 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2025;36(5): 190-199.

Procalcitonin elevation in acetaminophen intoxication without bacterial infection

Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea

Correspondence

Ji Hye Kim ,Tel: 032-890-2312, Fax: 032-890-2307, Email: ziihye@inha.ac.kr,

Received: June 22, 2024; Revised: October 20, 2024 Accepted: November 8, 2024. Published online: October 30, 2025.

ABSTRACT

Objective:
Procalcitonin (PCT) has become a biomarker for the diagnosis of bacterial infections because its levels are elevated in response to circulating endotoxins or cytokines. On the other hand, recent studies have noted elevated PCT levels in acute acetaminophen (APAP) intoxication without bacterial infection. This study investigated the clinical characteristics of PCT elevation in APAP intoxication and explored the potential mechanisms underlying this phenomenon.
Methods:
This retrospective observational study included patients admitted to a tertiary-care hospital with APAP intoxication. Clinical and laboratory data were collected, and the patients were categorized based on PCT elevation and the presence of acute liver injury (ALI). Statistical analyses were conducted to compare the variables between groups.
Results:
Among the 28 included patients, PCT elevation was observed in 11 cases, with ALI occurring only in this group. Significant differences were found in the time intervals from APAP ingestion to emergency department presentation and N-acetylcysteine (NAC) administration between patients with and without PCT elevation (P<0.001 and P<0.001, respectively). No significant differences between the PCT-elevated group with ALI and the PCT-elevated group without ALI were found in any of the variables, except for the duration of hospitalization (P=0.042).
Conclusion:
PCT elevation in APAP intoxication is associated with ALI and may reflect the underlying glutathione depletion that precedes ALI.

Key words: Procalcitonin; Acetaminophen; Poisoning; Chemical and drug induced liver injury