The Prognostic Value of Inflammatory Markers in Clostridium difficile-associated Diarrhea

Background: The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing and is associated with significant morbidity and mortality. Therefore, there is a need to find new toots to determine the severity of the disease. Objectives: To investigate the prognostic values of inflammatory markers such as mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), and C-reactive protein (CRP) in patients with CDAD. Methods: The study comprised of 100 patients diagnosed with CDAD. The study included an additional control group of 69 patients with diarrhea who were negative for C. difficile toxin. The control group was age- and sex-matched and hospitalized at the same time period. NLR and MPV were obtained from complete blood count results. Serum CRP levels were measured by the latex particle enhanced immunoturbidimetric assay. Blood samples for all inflammatory markers were collected at time of diagnosis and prior to initiating the antibiotic therapy. Demographic, clinical, laboratory, and prognostic data were collected from medical records for a period of 90 days from the initial diagnosis of CDAD. Results: The mean age of the CDAD group was 68.6 +/- 21.5 years compared to 65.6 +/- 24.5 in the control group (P = 0.29). Our findings show that patients with CDAD had significantly higher NLR, MPV, and serum CRP levels compared to the control group (P < 0.001). Moreover, significantly higher levels were observed when CDAD was fatal (P < 0.001). Conclusions: Elevated NLR, MPV, and serum CRP levels may serve as biomarkers for prediction of recurrence and mortality in patients with CDAD.