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Updated: Jun 14, 2025
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Clostridioides difficile Infection: Use of Inflammatory Biomarkers and Hemogram-Derived Ratios to Predict Mortality
Giuseppe Guido Maria Scarlata1, Angela Quirino2, Carmen Costache3,4
1Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
Insights
Neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) show potential in predicting mortality for patients with Clostridioides difficile infection (CDI). These inflammatory biomarkers can aid in risk stratification for better clinical outcomes.
Area of Science:
- Medical research
- Clinical diagnostics
- Infectious diseases
Background:
- Clostridioides difficile infection (CDI) is a major cause of mortality, particularly in healthcare settings.
- Accurate prediction of mortality in CDI patients requires reliable biomarkers.
- Current evaluation of inflammatory biomarkers and hemogram-derived ratios for CDI mortality prediction is limited.
Purpose of the Study:
- To evaluate the accuracy of inflammatory biomarkers and hemogram-derived ratios in predicting mortality in CDI patients.
- To assess the predictive value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-neutrophil ratio (PNR), derived neutrophil-to-lymphocyte ratio (dNLR), C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), and procalcitonin (PCT).
Main Methods:
- Retrospective analysis of CDI patients from Italian and Romanian hospitals (January 2020 - May 2023).
- Statistical analyses included t-tests, Wilcoxon rank-sum tests, chi-squared tests, and multivariate logistic regression.
- Receiver Operating Characteristic (ROC) analysis was used to assess biomarker accuracy.
Main Results:
- Neutrophil-to-lymphocyte ratio (NLR) demonstrated an Area Under Curve (AUC) of 0.652 with 72.5% sensitivity and 58.42% specificity.
- Systemic immune-inflammation index (SII) showed an AUC of 0.64 with 77.5% sensitivity and 54.74% specificity.
- Other markers like PNR, dNLR, CRP, and PCT exhibited lower or varied predictive values.
Conclusions:
- Neutrophils, dNLR, NLR, SII, and PNR are identified as valuable biomarkers for predicting mortality in CDI patients.
- These biomarkers can enhance risk stratification strategies for CDI patients.
- Improved understanding of these predictors can lead to better clinical outcomes.
Background:
Clostridioides difficile infection (CDI) is a significant cause of mortality, especially in healthcare environments. Reliable biomarkers that can accurately predict mortality in CDI patients are yet to be evaluated. Our study aims to evaluate the accuracy of several inflammatory biomarkers and hemogram-derived ratios in predicting mortality in CDI patients, such as the neutrophil-to-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), the platelet-to-neutrophil ratio (PNR), the derived neutrophil-to-lymphocyte ratio (dNLR), C-reactive protein (CRP), the platelet-to-lymphocyte ratio (PLR), and procalcitonin (PCT).
Results:
NLR showed a sensitivity of 72.5% and a specificity of 58.42% with an area under curve (AUC) = 0.652. SII had a sensitivity of 77.5%, a specificity of 54.74%, and an AUC = 0.64. PNR, neutrophils, dNLR, and lymphocytes had lower AUCs which ranged from 0.595 to 0.616, with varied sensitivity and specificity. CRP, leukocytes, and platelets showed modest predictive values with AUCs below 0.6. PCT had a sensitivity of 100%, a low specificity of 7.41%, and an AUC = 0.528.
Methods:
We conducted a retrospective analysis of CDI patients from two different hospital settings in Italy and Romania during the COVID-19 pandemic, from 1 January 2020 to 5 May 2023. Statistical analyses included t-tests, Wilcoxon rank-sum tests, χ2 tests, and multivariate logistic regression to identify predictors of mortality. ROC analysis assessed the accuracy of biomarkers and hemogram-derived ratios. A p value < 0.05 was considered significant.
Conclusions:
Neutrophils, dNLR, NLR, SII, and PNR are valuable biomarkers for predicting mortality in CDI patients. Understanding these predictors can improve risk stratification and clinical outcomes for CDI patients.
