From the Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.
Pediatr Emerg Care. 2022 Feb 1;38(2):e670-e673. doi: 10.1097/PEC.0000000000002414.
Differentiating bacterial origin in acute gastroenteritis (AGE) is important to improve outcomes. Fecal calprotectin is a sensitive screening tool for gut mucosal inflammation. This study aimed to evaluate the diagnostic efficacy and cutoff level of fecal calprotectin in distinguishing bacterial origin in pediatric AGE.
Patients who were diagnosed with AGE at 1 to 18 years between January 2015 and January 2020 were retrospectively analyzed. A polymerase chain reaction test was applied to stool samples to detect viruses and bacteria. The level of fecal calprotectin was determined using an enzyme-linked immunosorbent assay test.
Eighty patients were enrolled in this study. The most common viral pathogen was norovirus, and bacterial pathogen was Clostridium perfringens. The median fecal calprotectin level was 686 μg/g (interquartile range [IQR], 140-1192 μg/g) in all patients, 560 μg/g (IQR, 60-669 μg/g) in patients with viral pathogens, and 985 μg/g (IQR, 272-1984 μg/g) in those with bacterial pathogens (P = 0.019). The stool hemoglobin concentration (337.29 vs 84.83 ng/mL, P = 0.016) and C-reactive protein (4.06 vs 0.45 mg/dL, P = 0.082) levels were higher in patients with bacterial pathogens than in those with viral pathogens. For identifying bacterial pathogens, the area under the receiver operating characteristic curve of fecal calprotectin was 0.739 (95% confidence interval, 0.584-0.894); combination with stool hemoglobin improved diagnostic efficacy, and the area under the receiver operating characteristic curve was 0.870. The optimal cutoff values of fecal calprotectin and stool hemoglobin were 815 μg/g and 158 ng/mL, respectively.
The combination of stool hemoglobin and fecal calprotectin may be a useful marker for detecting bacterial etiology in pediatric AGE.
区分急性胃肠炎（AGE）的细菌来源对于改善预后很重要。粪便钙卫蛋白是一种用于检测肠道黏膜炎症的敏感筛查工具。本研究旨在评估粪便钙卫蛋白在鉴别儿科 AGE 细菌来源中的诊断效能和最佳截断值。
回顾性分析 2015 年 1 月至 2020 年 1 月期间 1 至 18 岁被诊断为 AGE 的患者。采用聚合酶链反应（PCR）检测粪便样本中的病毒和细菌。采用酶联免疫吸附试验（ELISA）检测粪便钙卫蛋白的水平。
本研究共纳入 80 例患者。最常见的病毒病原体是诺如病毒，细菌病原体是产气荚膜梭菌。所有患者的粪便钙卫蛋白中位数为 686μg/g（四分位距[IQR]，140-1192μg/g），病毒病原体患者为 560μg/g（IQR，60-669μg/g），细菌病原体患者为 985μg/g（IQR，272-1984μg/g）（P=0.019）。细菌病原体患者的粪便血红蛋白浓度（337.29 vs 84.83ng/mL，P=0.016）和 C 反应蛋白（4.06 vs 0.45mg/dL，P=0.082）水平高于病毒病原体患者。对于鉴别细菌病原体，粪便钙卫蛋白的受试者工作特征曲线下面积为 0.739（95%置信区间，0.584-0.894）；联合粪便血红蛋白可提高诊断效能，其受试者工作特征曲线下面积为 0.870。粪便钙卫蛋白和粪便血红蛋白的最佳截断值分别为 815μg/g 和 158ng/mL。
粪便血红蛋白和粪便钙卫蛋白的联合检测可能是儿科 AGE 检测细菌病因的有用标志物。
