Document Type

Conference Proceeding

Publication Date

5-1-2026

Abstract

Introduction Procalcitonin (PCT) is a biomarker that helps distinguish bacterial infections from other causes of infection or inflammation and can be used as a helpful adjunct to clinical judgment to resolve diagnostic uncertainty. However, the reliability of procalcitonin goes down when a patient has Acute kidney injury (AKI). Yet is there any significance for procalcitonin if it is extremely high, in hundreds, same in our patient, despite the patient in AKI and can PCT still be used to help determine mortality along with all other markers, or independent from other markers. Case report 36 years old male with PMH of alcohol use disorder, Asthma and hypertension. The patient presented to the emergency due to a two-day history of shortness of breath. The patient was in respiratory distress, which resulted in a limited history of present illness. Chest X-ray showed findings consistent with extensive right-sided pneumonia. On presentation, his oxygen saturation was 79%, and was placed on high flow nasal canula, but the patient continued to have respiratory distress. BiPAP deemed not appropriate because the patient was encephalopathic and lethargic at that time. The patient was intubated. Sedatives and paralytics were given during intubation. The patient started on Zosyn and Vancomycin, 30 ml/kg ringer lactate given, and ICU consulted Procalcitonin on presentation 36.12 Creatinine on presentation was 1.8 Two days later, procalcitonin went up to 742.02; however, creatinine went up to 5 The patient blood cultures were negative Legionella urine antigen was negative Strep. Pneumoniae antigen positive Patient progressed into resistant septic shock due to Streptococcus pneumoniae, was maxed out on Norepinephrine, phenylephrine, vasopressin, and epinephrine Patient became anuric and needed hemodialysis two days after admission Despite all efforts, the patient expired two days after admission Conclusion In this case report, we are discussing what can be common questions for each resident or physician when it comes how helpful procalcitonin can be in the case of AKI. In our patient we had multiple other markers pointed that the patient less likely to improve. However, what is the significance of the PCT in other patients with AKI if the patient clinically and chemically were not as critically ill as our patient. Can we use PCT along with other markers or independently from other markers to clinically judge how the patient will progress or whether the patient responding to antibiotics. Previous retrospective case-control observational study showed that the specificity of PCT may decrease in patients in AKI if current reference cutoff values are used to guide clinical decisions.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI

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