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Fecal calprotectin concentrations in cancer patients with Clostridium difficile infection

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Abstract

Fecal calprotectin (fCPT) has been used as a surrogate marker for assessment of intestinal inflammation. We explore the utility of fCPT values as a diagnostic aid in cancer patients with suspected Clostridium difficile infection (CDI). A total of 232 stool specimens submitted for GeneXpert C. difficile PCR testing were included in the study. All specimens were tested for fCPT and toxin/GDH antigens. Clinical severity of CDI cases was determined by the IDSA/SHEA criteria. Significant differences of median fCPT values between CDI (n = 117, Median 183.6 μg/g) and non-CDI (n = 115, 145.6 μg/g, p = 0.006) patients were seen. In CDI patents, significantly lower fCPT values were found in patients with mild to moderate (n = 95, 182.1 μg/g) than those with severe and severe to complicated (n = 22, 218.5 μg/g, p = 0.014) scores, and among those that were toxin positive (n = 24, 200.2 μg/g) vs. toxin negative (n = 86, 182.8 μg/g, p = 0.044). Despite this overall trend, wide variations in fCPT values were found in all categories examined. A logistic regression analysis revealed that the fCPT values correlated independently with the severity of clinical manifestations (OR = 2.021, 95%CI = 1.132–3.608); however, it did not correlate with other clinical outcomes. Our study findings show that high fecal calprotectin levels correlate with toxin-positive and clinically severe CDI; however, wide variations in individual measurements preclude establishment of reliable cut-offs for routine diagnostic use in cancer patients.

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Acknowledgments

We thank laboratory staff in the Clinical Microbiology Service at MSKCC for their excellent assistance.

Funding

This study was supported in part by the NIH/NCI Cancer Center Support Grant P30 (CA008748).

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Authors and Affiliations

  1. The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China

    Taojun He & Xuedong Lu

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Taojun He, Samuel E. Kaplan, Luz A. Gomez, Lakshmi V. Ramanathan, Mini Kamboj & Yi-Wei Tang

  3. Weill Medical College of Cornell University, New York, NY, USA

    Mini Kamboj & Yi-Wei Tang

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  1. Taojun He
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  2. Samuel E. Kaplan
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Correspondence to Yi-Wei Tang.

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Conflict of interest

The Phical Test was provided free of charge. No other reported conflicts.

Ethical approval

This study was approved by the Memorial Sloan Kettering Cancer Center Institutional Review Board (WA0477-15).

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He, T., Kaplan, S.E., Gomez, L.A. et al. Fecal calprotectin concentrations in cancer patients with Clostridium difficile infection. Eur J Clin Microbiol Infect Dis 37, 2341–2346 (2018). https://doi.org/10.1007/s10096-018-3381-9

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  • DOI: https://doi.org/10.1007/s10096-018-3381-9

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