Pediatr Gastroenterol Hepatol Nutr.  2019 Jul;22(4):369-376. 10.5223/pghn.2019.22.4.369.

Clinical Significance of Inflammatory Biomarkers in Acute Pediatric Diarrhea

• Park Y
• Son M
• Jekarl DW
• Choi HY
• Kim SY
• Lee S

• KMID: 2451577
• DOI: http://doi.org/10.5223/pghn.2019.22.4.369

Abstract

PURPOSE
The aim of this study was to evaluate the clinical significance of inflammatory biomarkers in acute infectious diarrhea among children.
METHODS
Clinical parameters including fever, bacterial and viral etiology based on stool culture and multiplex polymerase chain reaction, and nine biomarkers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocytes in blood and calprotectin, lactoferrin, myeloperoxidase, polymorphonuclear elastase, leukocytes, and occult blood in feces were evaluated in children who were hospitalized due to acute diarrhea without underlying disease.
RESULTS
A total of 62 patients were included. Among these patients, 33 had fever, 18 showed bacterial infections, and 40 patients were infected with 43 viruses. Of all the biomarkers, CRP was significantly correlated with fever (p<0.001). CRP, ESR, calprotectin, lactoferrin, myeloperoxidase, fecal leukocytes, and occult blood were significantly associated with infection with bacterial pathogens (p<0.001, p=0.04, p=0.03, p=0.003, p=0.02, p=0.03, p=0.002, respectively). The combination of CRP and fecal lactoferrin at their best cut-off values (13.7 mg/L and 22.8 µg/mL, respectively) yielded a sensitivity of 72.2%, and a specificity of 95.5% for bacterial etiology compared with their individual use.
CONCLUSION
Blood CRP is a useful diagnostic marker for both fever and bacterial etiology in acute pediatric diarrhea. The combination of CRP and fecal lactoferrin yields better diagnostic capability for bacterial etiology than their use alone for acute diarrhea in children without underlying gastrointestinal disease.

Keyword

C-reactive protein; Biomarkers; Lactoferrin; Child; Diarrhea

MeSH Terms

Bacterial Infections
Biomarkers*
Blood Sedimentation
C-Reactive Protein
Child
Diarrhea*
Feces
Fever
Gastrointestinal Diseases
Humans
Lactoferrin
Leukocyte L1 Antigen Complex
Leukocytes
Multiplex Polymerase Chain Reaction
Occult Blood
Pancreatic Elastase
Peroxidase
Sensitivity and Specificity
Biomarkers
C-Reactive Protein
Lactoferrin
Leukocyte L1 Antigen Complex
Pancreatic Elastase
Peroxidase

Figure

• 

  Fig. 1 Diarrheagenic pathogens detected in cultures and via multiplex polymerase chain reaction (n=62). C. difficile: Clostridium difficile, C. perfringens: Clostridium perfringens, E. coli: Escherichia coli.

• 

  Fig. 2 Receiver operator characteristic plots of CRP, fecal lactoferrin, and the combination of CRP and fecal lactoferrin at their best cut-off values (CRP at 13.7 mg/L, lactoferrin at 22.8 μg/mL). CRP: C-reactive protein.

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