Clostridium difficile infection (CDI) is a major nosocomial infection with manifestations that vary from mild disease to severe, life-threatening colitis. A major challenge for clinicians is identifying which patients will go on to experience adverse outcomes, especially at the earliest stages of disease when targeted, aggressive interventions could improve the prognosis. This project measured multiple inflammatory mediators in patients with CDI to assess whether they predicted complicated CDI.
Subjects were prospectively enrolled upon diagnosis of CDI by stool enzyme immunoassay for toxins A/B or polymerase chain reaction for the tcdB gene. Demographics, comorbidities, medications, vitals, and laboratory results were extracted from the chart. Sera were collected immediately after diagnosis and the levels of multiple inflammatory mediators were measured. The resulting values were log transformed and analyzed using principal component analysis and logistic regression for associations with the primary outcome of complicated CDI (admission to an intensive care unit, the need for abdominal surgery such as colectomy, and/or death attributable to CDI within 30 days of diagnosis).
A total of 170 subjects diagnosed with CDI were included in the analysis, of which 13 experienced complicated CDI (7.6%). Age (in years) was the only clinical variable that associated with complicated CDI (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.11, P =.008). The principal component analysis (Figure 1) showed that inflammatory mediator profiles were able to separate complicated from uncomplicated cases along an axis that explained 19.3% of the variation seen among subjects (P =.018). Main drivers of the difference along this axis (units of log pg/mL) were hepatocyte growth factor (HGF) (OR 2.07, 95% CI 1.26-3.72, P =.007), IL-6 (OR 1.77, 95% CI 1.11-2.94, P =.012), IL-8 (OR .207, 95% CI 1.16-3.69, P =.013), and elevated procalcitonin (PCT) (>0.5 ng/mL) (OR 6.13, 95% CI 1.38-27.2, P =.017) (Figure 1).
The serum inflammatory mediator profiles differ between patients with complicated and uncomplicated CDI. HGF, IL-6, IL-8, and PCT show promise as biomarkers but require prospective validation in a larger cohort alongside clinical variables used for adjusted analysis.
J. Mogle, None
A. T. Galecki, None
P. D. R. Higgins, None
V. B. Young, None
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