Undue Elevation of Procalcitonin in Pediatric Paracetamol Intoxication is Not Explained by Liver Cell Injury Alone

Tschiedel, Eva; Assert, Roland; Felderhoff-Müser, Ursula; Kathemann, Simone; Witzke, Oliver; Hoyer, Peter F.; Dohna-Schwake, Christian

doi:10.5604/01.3001.0012.0932

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…In a pediatric cohort study, Tschiedel et al. observed that paracetamol intoxication led to a marked increase in PCT serum levels, correlating with ALT but not correlating with the INR or paracetamol blood levels, consistent with our findings 33 …”

Section: Discussionsupporting

confidence: 92%

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

et al. 2021

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Background and Aims Acetaminophen is a common cause of poisoning and liver injury worldwide; however, patient stratification is suboptimal. We aimed to assess the contribution of admission plasma procalcitonin concentration (PCT) to better identify acetaminophen‐poisoned patients likely to develop liver injury. Methods We conducted a prospective observational cohort study including all acetaminophen‐poisoned patients requiring N‐acetylcysteine admitted in a toxicological intensive care unit between 2012 and 2017. Multivariate analysis was performed using a Cox regression model to investigate factors associated with liver injury, defined as an increase in alanine aminotransferase (ALT) >100 IU/L. Results One hundred seventeen patients (age, 32 years (21–53), median [25th–75th percentiles]) were included after self‐ingesting 16 g (9–30) acetaminophen and received N‐acetylcysteine infusion administered within a median 6 h‐delay (4–12) from exposure. Co‐ingestions were reported in 77% of patients. Rumack–Matthew nomogram was non‐interpretable in 47% cases. Liver injury occurred in 38 patients (32%) with a median peak ALT of 2020 IU/L (577–4248). In liver injury patients, admission PCT was significantly increased in comparison to patients without liver injury (21.5 ng/ml (3.2–44.9) versus 0.1 ng/ml (0–0.4), respectively, p < 0.01). The increase in PCT preceded the increase in ALT by 33 h (10–74). In a multivariate analysis, PCT > 1 ng/ml was significantly associated with liver injury (hazard ratio, 7.2 [95% confidence interval, 2.3–22.6; p < 0.001]). PCT (area under the receiver‐operating characteristics curve, 0.91 [95%CI: 0.84–0.97]) predicted liver injury with sensitivity, specificity, negative, and positive predictive values of 0.92, 0.84, 0.96, and 0.73, respectively. Conclusion PCT on admission is associated with liver injury in acetaminophen poisoning. PCT might be used as a predictive tool of liver injury to improve clinical decision‐making.

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Section: Discussionsupporting

confidence: 92%

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

et al. 2021

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“…Recientemente Tschiedel y cols. [7] han propuesto dos posibles mecanismos para explicar el aumento de procalcitonina en la intoxicación por paracetamol. El primero sería la propia hepatoxicidad inducida por el fármaco, que causaría la secreción de ciertas citoquinas, como la interleuquina 2 o el factor de necrosis tumoral alfa, que se comportarían como mediadores para la elevación de la concentración de procalcitonina.…”

Section: Discussionunclassified

“…Tschiedel y cols. [7] han sugerido la implicación en el incremento de procalcitonina asociado a la intoxicación por paracetamol de otros órganos como la célula endotelial a través de la producción de NAPQI.…”

Section: Intervalo De Referenciaunclassified

“…También se han descrito incrementos asociados al carcinoma de células C, pacientes quemados o traumatológicos [3] e intoxicaciones por drogas de abuso como las anfetaminas [4] o fármacos como el paracetamol [5], sin evidencia de infección bacteriana. En este último caso, el mecanismo de la elevación no ha sido aclarado y podría estar relacionado con la implicación de otros órganos, además del daño celular hepático [6][7][8].…”

Section: Introductionunclassified

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Incremento de las concentraciones de procalcitonina en pacientes intoxicados por paracetamol

Guadiana-Romualdo

Rojas

Arenas

et al. 2020

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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ResumenObjetivosLa intoxicación por paracetamol es una de las causas no infecciosas asociada al incremento de la concentración de procalcitonina. Presentamos dos casos de pacientes ingresados por intoxicación por paracetamol en el que los datos analíticos revelaron un aumento significativo de procalcitonina sin datos clínicos, radiológicos y/o microbiológicos de infección. El mecanismo que explicaría este incremento no ha sido aclarado.Caso clínicoSe presentan dos casos correspondientes a dos pacientes atendidos en el Servicio de Urgencias por intoxicación por paracetamol requiriendo ambos el ingreso en la Unidad de Cuidados Intensivos (UCI). Ambos mostraron un incremento de procalcitonina en las primeras horas de ingreso, sin evidencia clínica y/o microbiológica de infección que justificase dicho incremento. De forma llamativa, sólo el paciente 1 presentó disfunción hepática, con alteración de las concentraciones de alanino aminotransferasa (ALT), aspartato aminotransferasa (AST), bilirrubina y bilirrubina esterificada, hallazgos no observados en la paciente 2.Conclusioneslos pacientes presentados en este caso clínico mostraron un aumento de procalcitonina asociado a la intoxicación por paracetamol, pero sólo uno de ellos mostró signos de disfunción hepática. Ello sugiere que en la intoxicación por este fármaco la secreción del biomarcador no estaría solamente ligado al daño sobre el hepatocito, sino que otros mecanismos en los que estarían implicados otros órganos y tejidos contribuirían al aumento de procalcitonina. En cualquier caso, y aunque el mecanismo no ha sido perfectamente aclarado, es importante conocer esta limitación para el uso de procalcitonina como marcador de infección en pacientes intoxicados por paracetamol.

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“…Therefore, anaphylactic shock was strongly suspected. It is possible that the non-infectious pathway of procalcitonin increased due to increased oxidative stress after the administration of acetaminophen for hepatic injury caused by DIC [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy: a case study

et al. 2019

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Background: A spontaneous iliopsoas muscle hematoma is relatively rare and often associated with abnormal coagulation. Nafamostat mesilate is an anticoagulant agent that is sometimes used to treat hemodialysis patients at high risk of bleeding. Although severe drug allergy caused by nafamostat mesilate was previously reported, spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy has not yet been reported. Case presentation: Severe nafamostat mesilate allergy occurred in a 78-year-old male patient with a 2-year history of hemodialysis. During hospitalization, disseminated intravascular coagulation occurred followed by a progressive iliopsoas muscle hematoma a few days later. Emergent transarterial lumbar artery embolization was successfully performed. Conclusion: For dialysis patients, a detailed medical history including repeated nafamostat mesilate use and considering an allergy to nafamostat mesilate in differential diagnosis are critical. In addition to early diagnosis, when an iliopsoas hematoma occurs, early intravascular treatment is important.

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Undue Elevation of Procalcitonin in Pediatric Paracetamol Intoxication is Not Explained by Liver Cell Injury Alone

Abstract: The underlying mechanism is neither caused by infection nor fully explained by liver cell death alone and remains to be determined.

Cited by 10 publications

References 23 publications

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

Incremento de las concentraciones de procalcitonina en pacientes intoxicados por paracetamol

Spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy: a case study

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