Conclusions

The present study demonstrates that serial serum procalcitonin monitoring, particularly at 48 hours after admission, may serve as a highly effective prognostic tool in patients with acute-on-chronic pancreatitis. While admission PCT values alone demonstrated limited predictive utility, serial assessment provided excellent discrimination for mortality and severe disease outcomes. These findings emphasize the importance of systemic inflammatory kinetics, rather than isolated pancreatic injury markers, in determining prognosis in ACP. Integration of serial procalcitonin monitoring into structured management protocols may improve early risk stratification, optimize healthcare resource allocation, and support more individualized patient care in this complex inflammatory disorder.