Lab Med Online.  2020 Apr;10(2):125-131. 10.3343/lmo.2020.10.2.125.

Clinical Utility of Fecal Neutrophil Gelatinase-Associated Lipocalin and Calprotectin as Biomarkers of Clostridioides (Clostridium) difficile Infection

• Yi J
• Kim H
• Moon HW
• Hur M
• Yun YM

• KMID: 2512242
• DOI: http://doi.org/10.3343/lmo.2020.10.2.125

Abstract

Background
Current methods for diagnosing Clostridioides difficile infections (CDIs) fail to provide information on their severity. Fecal neutrophil gelatinase-associated lipocalin (NGAL) and calprotectin are candidate biomarkers for evaluating the severity of intestinal inflammation. We assessed fecal NGAL and calprotectin levels in patients with CDI and compared these values between subgroups of patients. We also evaluated their utility in predicting CDI clinical outcomes.
Methods
A total of 147 leftover fecal samples were obtained; 97 samples were from patients with CDI and 50 were from routine healthcare checkups. Fecal calprotectin and NGAL levels were measured using a Quantitative Fecal NGAL ELISA Kit and Quantitative Fecal Calprotectin ELISA Kit (Epitope Diagnostics, USA).
Results
Significant differences in fecal NGAL and calprotectin levels were observed between CDI patients and healthy controls (P<0.0001 for both). Significant differences in fecal NGAL and calprotectin levels were also seen between patients with high and low tcdB gene load (P=0.005 and 0.006, respectively). Fecal calprotectin levels were lower in patients with leukopenia (P=0.002), and high calprotectin levels were associated with severe CDI and treatment failure (P=0.021 and 0.033, respectively).
Conclusions
Fecal NGAL and calprotectin levels were higher in patients with CDI than in healthy controls and correlated with high tcdB gene loads. Leukopenia patients with CDI had significantly lower levels of calprotectin and the assessment should be regarded with caution. High fecal calprotectin levels were also associated with severe CDI and treatment failure. This warrants future studies with more patients and in-depth analyses.

Keyword

Clostridioides difficile; Fecal neutrophil gelatinase-associated lipocalin; Calprotectin

Figure

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  Fig. 1 Comparison of fecal (A) NGAL and (B) calprotectin levels in patients with CDI and healthy controls. All data are median and interquartile ranges.

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  Fig. 2 ROC curves for fecal (A) NGAL and (B) calprotectin levels in the healthy control group and patients with CDI.

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