Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN, USA.
Digestion. 2017 Nov;96(4):207-212. doi: 10.1159/000481133. Epub 2017 Oct 14.
BACKGROUND/AIMS: Clostridium difficile infection (CDI) frequently complicates ulcerative colitis (UC) and can mimic disease flare. Differentiating UC flare from CDI remains a clinical challenge, particularly due to C. difficile colonization. Procalcitonin (PCT) is a serum biomarker for bacterial infections. We hypothesized that PCT would differentiate acute CDI from UC flare and C. difficile colonization.
A single-center prospective cohort study was conducted from 2013 to 2016. All UC patients with a stool sample for C. difficile testing were eligible. A total of 117 patients were enrolled, while 20 were excluded. Chart review was performed.
Among 27 patients with CDI, median PCT was 60.7 (range 26-560.6) pg/mL, while among 90 patients without CDI, median PCT was 56.7 (range 25.1-2,252) pg/mL (p = 0.9). It was found that 14 patients with CDI responded completely to C. difficile treatment (CDI-R), while 8 patients did not and were diagnosed with UC flare (CDI-NR). For CDI-R, median PCT was 104.5 (range 26.3-560.6), compared to 40.3 (range 26.0-116.3) for CDI-NR (p = 0.036).
In UC patients presenting with diarrhea, serum PCT was not significantly higher in UC patients with positive C. difficile testing. However, PCT was significantly elevated in CDI-R versus CDI-NR, suggesting that PCT may have utility in making this discrimination.
背景/目的：艰难梭菌感染（CDI）常并发于溃疡性结肠炎（UC），且可能与疾病发作相类似。区分 UC 发作与 CDI 仍然具有临床挑战性，尤其是在艰难梭菌定植的情况下。降钙素原（PCT）是一种细菌感染的血清生物标志物。我们假设 PCT 将有助于区分急性 CDI 与 UC 发作和艰难梭菌定植。
本研究为 2013 年至 2016 年进行的单中心前瞻性队列研究。所有因艰难梭菌检测而接受粪便样本检查的 UC 患者均符合入选标准。共纳入 117 例患者，排除 20 例。进行了图表审查。
在 27 例 CDI 患者中，PCT 中位数为 60.7（范围 26-560.6）pg/mL，而在 90 例无 CDI 患者中，PCT 中位数为 56.7（范围 25.1-2252）pg/mL（p = 0.9）。发现 14 例 CDI 患者对艰难梭菌治疗完全有反应（CDI-R），而 8 例无反应且被诊断为 UC 发作（CDI-NR）。对于 CDI-R，PCT 中位数为 104.5（范围 26.3-560.6），而对于 CDI-NR，PCT 中位数为 40.3（范围 26.0-116.3）（p = 0.036）。
在出现腹泻的 UC 患者中，PCT 在艰难梭菌检测阳性的 UC 患者中并未显著升高。然而，在 CDI-R 与 CDI-NR 之间，PCT 显著升高，提示 PCT 可能有助于进行这种区分。
