Fecal calprotectin in management of Clostridium difficile infection: a longitudinal study

Background:Clostridium difficile infection (CDI) is characterized by a relevant intestinal neutrophil infiltrate. So far, role of fecal calprotectin in CDI, has been investigated only in few studies, mainly focused on diagnosis of the disease.Aim: By a longitudinal design, we assess fecal calprotectin concentrations (FCCs) in subjects with CDI, evaluating the correlation between fecal marker and response to therapy.Methods: Clinical (diarrhea scoring) and laboratory (FCCs and leucocytes count) evaluation was performed in 56 subjects with CDI at time of diagnosis (T-0) and after a week from starting of therapy (T-1). Clinical response to therapy at T-1 was related with both T-0 and T-1 FCC values. FCCs were also related to all-cause 30-day mortality, recurrence and death, both of them within 90 days.Results: FCCs at T-1 were significantly increased in subjects with persistence of diarrhea in respect to the other ones (285.5270 mu g/g vs 150.7 +/- 147 mu g/g, respectively; p<.05). Patients who did not respond to therapy showed higher, but not significative, FCCs at T-0 than patients who responded. No correlation was found among FCCs, both at T-0 and T-1, and the other outcomes.Conclusions: Longitudinal evaluation of FCCs in patients with CDI could support physicians in clinical management of disease, for example in term of duration (10 vs 14 days) or type (first vs second line therapy). Further and larger studies could confirm the eventual role of this marker in prognostic algorithms, mainly in prediction of recurrence.