The changes of fecal calprotectin and lactoferrin during Clostridioides difficile infection

Fecal calprotectin (FC) and fecal lactoferrin (FL) rise significantly in intestinal inflammation accompanied by neutrophil activation, such as Clostridioides difficile infection (CDI). The aim of the present study was to evaluate the benefit of FC and FL testing in CDI, and to assess the dynamics of changes in FC and FL during the treatment of this infection.

The study consisted of 69 participants, among them 39 patients with CDI and 30 persons in control group. Demographic data, blood tests information and clinical data were recorded using standardized data collection forms. Blood tests included complete blood count, C-reactive protein (CRP), procalcitonin (PCT), creatinine, glomerular filtration rate GFR, albumin, and lactate level. Subsequently, stool samples were cultured, and the isolated strains were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). FC and FL level were measured using ELISA tests.

FC level was significantly higher in the CDI group versus control group. After seven days of treatment, the level of FC decreased insignificantly and did not reach the values seen in the control group. FL was also higher at disease onset compared to the control group yet remained elevated seven days after initiating treatment; in fact, a statistically significant increase was observed. Significant correlations were demonstrated between baseline FL levels and the following parameters: maximum temperature, WBC count, neutrophil count, PCT, albumin, and creatinine.

FC and FL are useful markers in diagnosing CDI, and FL appears to be a promising biomarker of evaluating CDI severity.