Fecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children.
BACKGROUND
Calprotectin is a marker associated with intestinal inflammation. The aim of this study is to explore the diagnostic value of fecal calprotectin in predicting bacterial/viral diarrhea and the application of fecal calprotectin in the clinical course of infectious diarrhea.


METHODS
Patients ages from 3 months to 10 years with infectious diarrhea were enrolled, and from each patient, 2 to 3 stool samples were collected. Fecal calprotectin levels were determined by enzyme-linked immunosorbent assay and compared by pathogen and disease activity. A univariate linear regression was used to determine the correlation between fecal calprotectin and the clinical parameters, and generalized estimating equations (GEEs) were used for the time course analyses.


RESULTS
The data include 451 evaluations for 153 individuals across 3 different time points. The fecal calprotectin level was higher in patients with Salmonella infection (median with range 765 [252-1246] μg/g) or Campylobacter infection (689 [307-1046] μg/g) compared with patients with rotavirus infection (89 [11-426] μg/g), norovirus infection (93 [25-405] μg/g), or adenovirus infection (95 [65-224] μg/g). Fecal calprotectin concentrations were elevated in patients with severe (843 [284-1246] μg/g) or moderate (402 [71-995] μg/g) disease activity compared with those with mild (87 [11-438] μg/g) disease activity (P < 0.05). GEE analysis suggests that fecal calprotectin is correlated with clinical severity (e.g., Vesikari score) and may provide information for disease management.


CONCLUSIONS
Fecal calprotectin levels increased during bacterial infection and as disease severity increased, and its levels on the initial evaluation and follow-up visit are correlated with clinical severity. Fecal calprotectin may be a useful marker for application in children during infectious diarrhea.
Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chien-Chang
CC
Chen
Jing-Long
JL
Huang
Chee-Jen
CJ
Chang
Man-Shan
MS
Kong
D000256:Adenoviridae; D015415:Biomarkers / Q000378:metabolism; D002167:Campylobacter; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000378:metabolism* / Q000382:microbiology / Q000821:virology; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000378:metabolism* / Q000382:microbiology / Q000821:virology; D015212:Inflammatory Bowel Diseases / Q000378:metabolism* / Q000382:microbiology / Q000821:virology; D007413:Intestinal Mucosa / Q000378:metabolism*; D007422:Intestines / Q000382:microbiology / Q000821:virology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D029322:Norovirus; D012401:Rotavirus; D012475:Salmonella; D012720:Severity of Illness Index
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex