Fecal Calprotectin in Nosocomial Diarrhea: A Prospective Observational Study

Wichaya Jaroonsakchai; Julajak Limsrivilai; Phutthaphorn Phaophu; Nichcha Subdee; Popchai Ngamskulrungroj; Nonthalee Pausawasdi; Phunchai Charatcharoenwitthaya; Supot  Pongprasobchai

doi:10.33192/smj.v76i4.267058

Authors

Wichaya Jaroonsakchai 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Julajak Limsrivilai 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Phutthaphorn Phaophu 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nichcha Subdee 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Popchai Ngamskulrungroj Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nonthalee Pausawasdi 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Phunchai Charatcharoenwitthaya 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Supot Pongprasobchai 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v76i4.267058

Keywords:

calprotectin, nosocomial, diarrhea, tube-feeding

Abstract

Objective: Fecal calprotectin (FC) has an essential role in differentiating inflammatory diarrhea from functional diarrhea in an outpatient setting; however, its role in nosocomial diarrhea remains not well explored.

Materials and Methods: This is a prospective observational study. We included adult inpatients with nosocomial diarrhea and categorized them into diarrhea likely (group A) and unlikely (group B) to have lesions in the colonic mucosa. Group A included infectious diarrhea such as Clostridium difficile and ischemic colitis. Group B comprised tube-feeding diarrhea, non-C. difficile antibiotic-associated diarrhea, and drug-induced diarrhea. The FC levels were compared between the two groups.

Results: 135 patients were included, 45 in group A and 90 in group B. Median FC was 902 mg/kg (interquartile range [IQR] 549-2,175) of feces in group A, significantly higher than the median level of 377 mg/kg (IQR 141-664) of feces in group B (p<0.001). The area under the receiver operating characteristic curve was 0.798 (95% confidence interval: 0.717-0.879). At the standard cutoff of 50 mg/kg of feces, the sensitivity and specificity were 97.8% and 7.8%, respectively.

Conclusion: FC was significantly higher in nosocomial diarrhea likely to have mucosal lesions; however, its clinical usefulness was limited due to poor specificity.

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