Fecal calprotectin: can be used to distinguish between bacterial and viral gastroenteritis in children?

• Published in: The American journal of emergency medicine Vol. 33; no. 10; pp. 1436 - 1439
• Main Authors: Duman, Murat, MD, Gencpinar, Pinar, MD, Biçmen, Meral, PhD, Arslan, Nur, MD, Özden, Ömer, MD, Üzüm, Özlem, MD, Çelik, Durgül, MD, Sayıner, A. Arzu, MD, Gülay, Zeynep, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Acute Disease; Adenovirus; Adenoviruses; Age; Area Under Curve; Astrovirus; Bacteria; Bacterial Infections - diagnosis; Bacterial Infections - microbiology; Biomarkers - analysis; Chi-Square Distribution; Child; Child, Preschool; Diarrhea; Diarrhea - microbiology; Emergency; Emergency medical care; Enzyme-Linked Immunosorbent Assay; Feces; Feces - chemistry; Feces - microbiology; Female; Fever; Gastroenteritis - microbiology; Humans; Inflammatory bowel disease; Leukocyte L1 Antigen Complex - analysis; Male; Microscopy; Patients; Prospective Studies; Real-Time Polymerase Chain Reaction; Rotavirus; Salmonella; Statistical analysis; Statistics, Nonparametric; Viral infections; Virus Diseases - diagnosis; Virus Diseases - virology; Viruses; Vomiting
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.07.007

Abstract Objective Fecal calprotectin is used as a good indicator of intestinal mucosal inflammation. The aim of this study is to evaluate the diagnostic value of fecal calprotectin (f-CP) for the etiology of acute gastroenteritis in children. Materials and methods All patients presenting with acute diarrhea (< 18 years) who had 3 or more soft or watery stools per day were enrolled in this study. Stool microscopic examination and cultures for bacteria and parasites were performed. Polymerase chain reaction test was also applied to stool samples for viruses ( Rotavirus , Adenovirus , Norwalk , and Astrovirus ). The level of f-CP was carried out by using enzyme-linked immunosorbent assay test. Results Eighty-four patients with diarrhea were enrolled. The f-CP level was higher in patients with microscopic examination positive (n = 17) (median with interquartile range, 1610.0 [908.8-2100] mg/L) than in patients with microscopic examination negative (n = 67) (123.8 [25.0-406.3] mg/L) ( P < .001). Concentrations of f-CP in patients with stool culture positive (1870.0 [822.5-2100] mg/L) were significantly elevated compared with the concentrations of the patient with virus detected in stool (95.0 [21.3-240.9] mg/L) ( P < .001). In the diagnosis for bacterial acute gastroenteritis, the area under the receiver operating characteristic curve for f-CP was 0.867 (95% confidence interval, 0.763-0.971), sensitivity was 88.9%, and specificity was 76.0% if the threshold was taken as 710 mg/L. Conclusion We conclude that f-CP, which is useful, valuable, noninvasive, easily and rapidly measured laboratory test along with simple microscopic examination of stool, can be used as an indicator of intestinal inflammation and to distinguish the bacterial gastroenteritis from the viral gastroenteritis.