Fecal Calprotectin in Nosocomial Diarrhea: A Prospective Observational Study
DOI:
https://doi.org/10.33192/smj.v76i4.267058Keywords:
calprotectin, nosocomial, diarrhea, tube-feedingAbstract
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.
References
Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology. 2009;136(6):1874-86.
Reintam Blaser A, Deane AM, Fruhwald S. Diarrhoea in the critically ill. Curr Opin Crit Care. 2015;21(2):142-53.
Granville LA, Cernoch P, Land GA, Davis JR. Performance assessment of the fecal leukocyte test for inpatients. J Clin Microbiol. 2004;42(3):1254-6.
Pitta MR, Campos FM, Monteiro AG, Cunha AGF, Porto JD, Gomes RR. Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-By-Step Approach. JPEN J Parenter Enteral Nutr. 2019;43(8):1008-19.
Menees SB, Powell C, Kurlander J, Goel A, Chey WD. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol. 2015; 110(3):444-54.
Whitehead SJ, Shipman KE, Cooper M, Ford C, Gama R. Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples? J Med Microbiol. 2014;63(Pt 4):590-3.
Popiel KY, Gheorghe R, Eastmond J, Miller MA. Usefulness of Adjunctive Fecal Calprotectin and Serum Procalcitonin in Individuals Positive for Clostridium difficile Toxin Gene by PCR Assay. J Clin Microbiol. 2015;53(11):3667-9.
Barbut F, Gouot C, Lapidus N, Suzon L, Syed-Zaidi R, Lalande V, et al. Faecal lactoferrin and calprotectin in patients with Clostridium difficile infection: a case-control study. Eur J Clin Microbiol Infect Dis. 2017;36(12):2423-30.
Swale A, Miyajima F, Roberts P, Hall A, Little M, Beadsworth MB, et al. Calprotectin and lactoferrin faecal levels in patients with Clostridium difficile infection (CDI): a prospective cohort study. PLoS One. 2014;9(8):e106118.
Kim J, Kim H, Oh HJ, Kim HS, Hwang YJ, Yong D, et al. Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection. Ann Lab Med. 2017;37(1):53-57.
Peretz A, Tkhawkho L, Pastukh N, Brodsky D, Halevi CN, Nitzan O. Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection. BMC Infect Dis. 2016;16:309.
Monica Lopez-Raton MXR-A, Carmen Cadarso Suarez, Francisco Gude Sampedro. OptimalCutpoints: An R Package for Selecting Optimal Cutpoints in Diagnostic Tests. Journal of Statistical Software. 2014;61(8):1-36.
Smalley W, Falck-Ytter C, Carrasco-Labra A, Wani S, Lytvyn L, Falck-Ytter Y. AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology. 2019;157(3):851-4.
Whitehead SJ, Shipman KE, Cooper M, Ford C, Gama R. Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples? J Med Microbiol. 2014;63(Pt 4):590-3.
He T, Kaplan SE, Gomez LA, Lu X, Ramanathan LV, Kamboj M, et al. Fecal calprotectin concentrations in cancer patients with Clostridium difficile infection. Eur J Clin Microbiol Infect Dis. 2018;37(12):2341-6.
Schippa S, Conte MP. Dysbiotic events in gut microbiota: impact on human health. Nutrients. 2014;6(12):5786-805.
Barnes A, Spizzo P, Mountifield R. Inpatient usage of faecal calprotectin in a tertiary hospital. Intern Med J. 2020;52(3):436-9.
Kong LY, Davies K, Wilcox MH. The perils of PCR-based diagnosis of Clostridioides difficile infections: Painful lessons from clinical trials. Anaerobe. 2019;60:102048.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Siriraj Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Users are free to share, copy, and redistribute all articles published in the Siriraj Medical Journal (SMJ) in any medium or format as long as you follow the following terms:
- Attribution — You must give appropriate credit, provide a link to the material, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the publisher endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
- NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
