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192 Elevation of C-reactive protein is Associated with Severity of Clostridium difficile Infection

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Dubert Medina Guerrero, MD , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Lucy A. Jury , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Suresh Ponnada, MD , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Curtis J. Donskey, MD , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Background: Current guidelines recommend stratification of patients based on severity and complexity of illness to determine initial choices for treatment of Clostridium difficile infection (CDI), thus there is a need to determine clinical predictors for severity of infection.

Objective: To test the hypothesis that c-reactive (CRP) protein is increased in severe CDI.

Methods: An 8-month prospective study of CDI patients was conducted at the Cleveland Veterans Affairs Medical Center. Severity of illness was assessed using the criteria proposed by Zar (CID, 2007). Patient interview and chart review were conducted to determine clinical and laboratory risk factors for severe CDI including CRP. Student’s t test, chi square and Fisher exact test were used for analysis. A linear regression was used to test the hypothesis that CRP increases with severity.

Results: Among 82 CDI patients, 29 (35%) had severe disease. The table compares laboratory and clinical factors of CDI patients with and without severe disease. A total of 28 (97%) patients with severe CDI have elevated CRP (level > 1.0 mg/dl) compared to 41 (77%) among those with non-severe illness (P=0.027). Patients with severe CDI had a higher mean CRP levels compared to those with non-severe CDI (7.7 mg/dl [range 0.9-17] versus 3.1 mg/dl [range 0.3-13], P<0.001). Severity increased CRP by a mean of 4.6 mg/dl. Presence of other concomitant probable or definite infections was not a significant explanatory variable for elevations in CRP.

Conclusions: Along with previously documented laboratory parameters such as leukocytosis, hypoalbuminemia and renal insufficiency, CRP elevation may be used in predicting severity of CDI.

 

Risk factor

Severe CDI

(n=29)

Non-severe CDI

(n =53)

P value

C-reactive protein, mg/dl

7.7 [0.9-17]

3.1 [0.3-13]

<.001

Frequency of diarrhea per day

5 [2-11]

4 [1-12]

.18

White count, x10^3/uL

12.9 +/-5.2

9.9+/-4.0

.005

albumin level <2.5 g/dL

16 (55)

12 (23)

.004

Creatinine >1.5x baseline

10 (34)

7 (13)

.007

Concomitant probable or definite infection

16 (55)

23 (43)

.3