Fecal Calprotectin Level in Patients With Nosocomial Diarrhea

NCT ID: NCT04491799

Last Updated: 2021-04-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

135 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-02-01

Study Completion Date

2020-10-30

Brief Summary

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Nosocomial diarrhea is a common problem.There are multiple ethiologies of nosocomial diarrhea in which can be divided into inflammatory and non inflammatory diarrhea. Fecal calprotectin is a good marker to identify inflammatory diarrhea in outpatient setting; for example, differentiating inflammatory bowel disease and irritable bowel syndrome. Its performance in inpatient setting has not been well established. This study aim to determine the efficacy of fecal calprotectin in distinguishing inflammatory nosocomial diarrhea from non-inflammatory nosocomial diarrhea.

Detailed Description

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This is a prospective, cross-sectional, and observational study. The patients with nosocomial diarrhea whose stool samples are sent for stool examination and Clostridium difficile toxin by their treating physicians will be recruited. Their leftover stool samples will be kept at - 80 c and will be measured for calprotectin level at the end of study. The patients will be treated by their treating physicians. They will be classified into 2 groups - inflammatory and non-inflammatory diarrhea.

The inflammatory diarrhea will be defined if 1) positive for C. difficile toxin or 2) stool WBC more than 5/HPF or 3) inflammatory mucosa or ulceration noted on colonoscopy.

The noninflammatory diarrhea will be defined if 1)negative for C. difficile toxin and 2) no WBC on stool examination and 3) dramatic response to diet adjustment or 4) no mucosal inflammation or ulceration if colonoscopy is performed

The patients who do not respond to diet modification, but do not undergo colonoscopy will be excluded because the definite diagnosis cannot be made.

Conditions

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Diarrhea Calprotectin

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Nosocomial diarrhea

Patients who are hospitalized and develop diarrhea after 72 hours of hospitalization.

Fecal calprotectin

Intervention Type DIAGNOSTIC_TEST

Fecal calprotectin is a protein found in human neutrophils, and it is released during active periods of inflammation of intestine. The sensitivity and specificity has been reported at 93% and 96%, respectively in differentiating inflammatory bowel disease from irritable bowel syndrome in outpatient setting.

Interventions

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Fecal calprotectin

Fecal calprotectin is a protein found in human neutrophils, and it is released during active periods of inflammation of intestine. The sensitivity and specificity has been reported at 93% and 96%, respectively in differentiating inflammatory bowel disease from irritable bowel syndrome in outpatient setting.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* age more than 18 hear
* Diarrhea more than 3 time per day after admitted in hospital more than 72 hours

Exclusion Criteria

* intraabdominal pressure more than 12 mmHg
* patient on chemotherapy with neutropenia ,ANC less than 1,000/mm3
* patients whose definite diagnosis cannot be obtained
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mahidol University

OTHER

Sponsor Role lead

Responsible Party

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Julajak Limsrivilai

Assist.Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Julajak Limsrivilai, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Siriraj Hospital

Locations

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Siriraj hospital

Bangkok, , Thailand

Site Status

Countries

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Thailand

References

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Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology. 2009 May;136(6):1874-86. doi: 10.1053/j.gastro.2009.02.072. Epub 2009 May 7.

Reference Type BACKGROUND
PMID: 19457416 (View on PubMed)

Reintam Blaser A, Deane AM, Fruhwald S. Diarrhoea in the critically ill. Curr Opin Crit Care. 2015 Apr;21(2):142-53. doi: 10.1097/MCC.0000000000000188.

Reference Type BACKGROUND
PMID: 25692805 (View on PubMed)

Chang SJ, Huang HH. Diarrhea in enterally fed patients: blame the diet? Curr Opin Clin Nutr Metab Care. 2013 Sep;16(5):588-94. doi: 10.1097/MCO.0b013e328363bcaf.

Reference Type BACKGROUND
PMID: 23799327 (View on PubMed)

Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002 Jan 31;346(5):334-9. doi: 10.1056/NEJMcp011603. No abstract available.

Reference Type BACKGROUND
PMID: 11821511 (View on PubMed)

Siciliano RF, Castelli JB, Randi BA, Vieira RD, Strabelli TM. Cytomegalovirus colitis in immunocompetent critically ill patients. Int J Infect Dis. 2014 Mar;20:71-3. doi: 10.1016/j.ijid.2013.11.008. Epub 2014 Jan 6.

Reference Type BACKGROUND
PMID: 24406737 (View on PubMed)

Manabe YC, Vinetz JM, Moore RD, Merz C, Charache P, Bartlett JG. Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med. 1995 Dec 1;123(11):835-40. doi: 10.7326/0003-4819-123-11-199512010-00004.

Reference Type BACKGROUND
PMID: 7486465 (View on PubMed)

Crobach MJ, Dekkers OM, Wilcox MH, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect. 2009 Dec;15(12):1053-66. doi: 10.1111/j.1469-0691.2009.03098.x.

Reference Type BACKGROUND
PMID: 19929972 (View on PubMed)

van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010 Jul 15;341:c3369. doi: 10.1136/bmj.c3369.

Reference Type BACKGROUND
PMID: 20634346 (View on PubMed)

Menees SB, Powell C, Kurlander J, Goel A, Chey WD. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol. 2015 Mar;110(3):444-54. doi: 10.1038/ajg.2015.6. Epub 2015 Mar 3.

Reference Type BACKGROUND
PMID: 25732419 (View on PubMed)

Mosli MH, Zou G, Garg SK, Feagan SG, MacDonald JK, Chande N, Sandborn WJ, Feagan BG. C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2015 Jun;110(6):802-19; quiz 820. doi: 10.1038/ajg.2015.120. Epub 2015 May 12.

Reference Type BACKGROUND
PMID: 25964225 (View on PubMed)

Whitehead SJ, Shipman KE, Cooper M, Ford C, Gama R. Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples? J Med Microbiol. 2014 Apr;63(Pt 4):590-593. doi: 10.1099/jmm.0.067389-0. Epub 2014 Jan 25.

Reference Type BACKGROUND
PMID: 24464697 (View on PubMed)

Popiel KY, Gheorghe R, Eastmond J, Miller MA. Usefulness of Adjunctive Fecal Calprotectin and Serum Procalcitonin in Individuals Positive for Clostridium difficile Toxin Gene by PCR Assay. J Clin Microbiol. 2015 Nov;53(11):3667-9. doi: 10.1128/JCM.02230-15. Epub 2015 Sep 9.

Reference Type BACKGROUND
PMID: 26354814 (View on PubMed)

Barbut F, Gouot C, Lapidus N, Suzon L, Syed-Zaidi R, Lalande V, Eckert C. Faecal lactoferrin and calprotectin in patients with Clostridium difficile infection: a case-control study. Eur J Clin Microbiol Infect Dis. 2017 Dec;36(12):2423-2430. doi: 10.1007/s10096-017-3080-y. Epub 2017 Aug 12.

Reference Type BACKGROUND
PMID: 28801865 (View on PubMed)

Swale A, Miyajima F, Roberts P, Hall A, Little M, Beadsworth MB, Beeching NJ, Kolamunnage-Dona R, Parry CM, Pirmohamed M. Calprotectin and lactoferrin faecal levels in patients with Clostridium difficile infection (CDI): a prospective cohort study. PLoS One. 2014 Aug 29;9(8):e106118. doi: 10.1371/journal.pone.0106118. eCollection 2014.

Reference Type BACKGROUND
PMID: 25170963 (View on PubMed)

Kim J, Kim H, Oh HJ, Kim HS, Hwang YJ, Yong D, Jeong SH, Lee K. Fecal Calprotectin Level Reflects the Severity of Clostridium difficile Infection. Ann Lab Med. 2017 Jan;37(1):53-57. doi: 10.3343/alm.2017.37.1.53.

Reference Type BACKGROUND
PMID: 27834066 (View on PubMed)

Peretz A, Tkhawkho L, Pastukh N, Brodsky D, Halevi CN, Nitzan O. Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection. BMC Infect Dis. 2016 Jun 22;16:309. doi: 10.1186/s12879-016-1618-8.

Reference Type BACKGROUND
PMID: 27334992 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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Si056/2019

Identifier Type: -

Identifier Source: org_study_id

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