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Updated: Oct 25, 2025
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Laboratory markers predictive of fulminant Clostridioides difficile infection refractory to fluid resuscitation
Omar Ahmad1, Timothy N Crawford2, Vaneet Arora3
1Division of Infectious Diseases, University of Kentucky, 740 S. Limestone Street K512, Lexington, 40536, KY, USA.
Insights
Hypoalbuminemia and high ATLAS scores in patients with Clostridioides difficile infection (CDI) may predict severe complications like shock or ileus. These findings are crucial for identifying high-risk patients on optimal therapy.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
Background:
- Clostridioides difficile infection (CDI) poses significant risks, with traditional risk factors identified in patients on older treatment regimens.
- Reassessing risk factors like hypoalbuminemia and elevated ATLAS scores is crucial for patients receiving current optimal CDI therapy.
Purpose of the Study:
- To re-evaluate risk factors for severe and fulminant Clostridioides difficile infection (CDI) in patients treated with optimal therapy.
- To identify predictors of critical illness progression in hypotensive CDI patients.
Main Methods:
- Retrospective review of hospitalized adult patients with CDI.
- Classification of patients into non-severe/severe and fulminant CDI groups, with further subdivision of fulminant cases.
- Correlation analysis to assess relationships between clinical variables and disease severity.
Main Results:
- Declining albumin levels and increasing ATLAS scores correlated with worsening disease severity in fulminant CDI.
- Low albumin (< 20 g/L) and high ATLAS scores (≥ 6) were significant predictors of critical illness in hypotensive patients.
- WBC counts were similar between fulminant subgroups, but albumin and ATLAS scores differed.
Conclusions:
- Hypoalbuminemia and high ATLAS scores are potential early indicators of progression to shock, ileus, or megacolon in hypotensive CDI patients.
- These markers may aid in risk stratification and timely intervention for severe CDI.
- Findings emphasize the importance of albumin levels and ATLAS scores in managing CDI patients on optimal therapy.
Background:
Old age, leucocytosis, hypoalbuminemia, and elevated creatinine have been identified as risk factors for fulminant Clostridioides difficile infection (CDI). High ATLAS scores have also been linked to fatal disease. The affiliated studies, however, involved patients prescribed metronidazole - a regimen no longer standard of care. The variables were thus reassessed in patients prescribed optimal therapy.
Methods:
Adults hospitalized with CDI at University of Kentucky Medical Center were retrospectively reviewed. Enrolled subjects were separated according to disease classification i.e. non-severe/severe versus fulminant CDI. Fulminant patients were further subdivided into hypotensive persons responsive to fluid resuscitation, and those with sequent shock, ileus, or megacolon. Following partition, the cohorts underwent correlation analysis.
Findings:
Forty-five subjects had non-severe/severe disease. Thirteen fulminant CDI patients responded to fluid resuscitation. Seventeen fulminant CDI patients developed shock, ileus, or megacolon. Median WBC counts, albumin values, and ATLAS scores varied among the cohorts. Although WBC counts were similar among the fulminant subsets, declining albumin values and increasing ATLAS scores mirrored disease worsening. Logistic regression revealed albumin values < 20 g/L (odds ratio [OR] 3.91) and ATLAS scores ≥ 6 (OR 5.03) to predict critical illness in hypotensive persons.
Conclusion:
Median WBC counts, albumin values, and ATLAS scores differed in patients separated by CDI severity. A notable variance in albumin values and ATLAS scores between fluid responsive fulminant disease and critical illness was moreover seen. The finding suggests hypoalbuminemia and high ATLAS scores in hypotensive CDI patients may herald shock, ileus, or megacolon.
