calca-protein--human and Enterocolitis--Pseudomembranous

In 54/64 subjects with nosocomial diarrhea, fecal calprotectin levels correlated with the results of stool samples tested for Clostridium difficile toxin gene by PCR. Fecal calprotectin levels can be used as an adjunctive measure to PCR to support the diagnosis of C. difficile infection.

Topics: Bacterial Toxins; Biological Assay; Calcitonin; Calcitonin Gene-Related Peptide; Clostridioides difficile; Creatinine; Cross Infection; Enterocolitis, Pseudomembranous; Enterotoxins; Feces; Female; Humans; Leukocyte L1 Antigen Complex; Male; Middle Aged; Polymerase Chain Reaction; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Serum Albumin

Clostridium difficile infection (CDI) is a major cause of morbidity and biomarkers that predict severity of illness are needed. Procalcitonin (PCT), a serum biomarker with specificity for bacterial infections, has been little studied in CDI. We hypothesized that PCT associated with CDI severity.. Serum PCT levels were measured for 69 cases of CDI. Chart review was performed to evaluate the presence of severity markers and concurrent acute bacterial infection (CABI). We defined the binary variables clinical score as having fever (T >38°C), acute organ dysfunction (AOD), and/or WBC >15,000 cells/mm(3) and expanded score, which included the clinical score plus the following: ICU admission, no response to therapy, colectomy, and/or death.. In univariate analysis log10 PCT associated with clinical score (OR 3.13, 95% CI 1.69-5.81, P<.001) and expanded score (OR 3.33, 95% CI 1.77-6.23, P<.001). In a multivariable model including the covariates log10 PCT, enzyme immunoassay for toxin A/B, ribotype 027, age, weighted Charlson-Deyo comorbidity index, CABI, and extended care facility residence, log10 PCT associated with clinical score (OR 3.09, 95% CI 1.5-6.35, P = .002) and expanded score (OR 3.06, 95% CI 1.49-6.26, P = .002). PCT >0.2 ng/mL was 81% sensitive/73% specific for a positive clinical score and had a negative predictive value of 90%.. An elevated PCT level associated with the presence of CDI severity markers and CDI was unlikely to be severe with a serum PCT level below 0.2 ng/mL. The extent to which PCT changes during CDI therapy or predicts recurrent CDI remains to be quantified.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clostridioides difficile; Enterocolitis, Pseudomembranous; Female; Humans; Male; Middle Aged; Odds Ratio; Prognosis; Protein Precursors; Recurrence; Retrospective Studies; ROC Curve; Severity of Illness Index; Young Adult