Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2011; 17(37): 4218-4224
Published online Oct 7, 2011. doi: 10.3748/wjg.v17.i37.4218
Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea
Chien-Chang Chen, Chee-Jen Chang, Tzou-Yien Lin, Ming-Wei Lai, Hsun-Chin Chao, Man-Shan Kong
Chien-Chang Chen, Ming-Wei Lai, Hsun-Chin Chao, Man-Shan Kong, Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China
Chien-Chang Chen, Ming-Wei Lai, Hsun-Chin Chao, Man-Shan Kong, Department of Medicine, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan, China
Chee-Jen Chang, Graduate Institute of Clinical Medical Sciences, Clinical Informatics and Medical Statistics Research Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China
Chee-Jen Chang, Department of Medicine, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan, China
Tzou-Yien Lin, Division of Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China
Tzou-Yien Lin, Department of Medicine, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan, China
Author contributions: Chen CC, Chang CJ and Kong MS performed the majority of the experiments; Chang CJ, Lin TY, Lai MW and Chao HC provided the vital reagents and analytical tools and were also involved in editing the manuscript; Chen CC and Kong MS designed the study and wrote the manuscript.
Supported by Chang Gung Memorial Hospital research project grants CMRPG470051-470052
Correspondence to: Man-Shan Kong, MD, Assistant Professor of Pediatrics, Attending physician, Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital; Department of Medicine, Chang Gung University, College of Medicine, 12L, 5 Fu-Hsing St, Kwei-Shan, Taoyuan 333, Taiwan, China. pedcgl1969@gmail.com
Telephone: +886-3-3281200 Fax: +886-3-3288957
Received: May 3, 2011
Revised: July 11, 2011
Accepted: July 18, 2011
Published online: October 7, 2011
Abstract

AIM: To explore the value of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea.

METHODS: Patients with acute infectious diarrhea ranging from 3 mo to 10 years in age were enrolled, and one to three stool samples from each subject were collected. Certain parameters, including white blood cells /differential count, C-reactive protein, fecal mucus, fecal pus cells, duration of fever, vomiting, diarrhea and severity (indicated by Clark and Vesikari scores), were recorded and analyzed. Fecal lactoferrin was determined by enzyme-linked immunosorbent assay and compared in different pathogen and disease activity. Generalized estimating equations (GEE) were also used for analysis.

RESULTS: Data included 226 evaluations for 117 individuals across three different time points. Fecal lactoferrin was higher in patients with Salmonella (11.17 μg/g ± 2.73 μg/g) or Campylobacter (10.32 μg/g ± 2.94 μg/g) infections and lower in patients with rotavirus (2.82 μg/g ± 1.27 μg/g) or norovirus (3.16 μg/g ± 1.18 μg/g) infections. Concentrations of fecal lactoferrin were significantly elevated in patients with severe (11.32 μg/g ± 3.29 μg/g) or moderate (3.77 μg/g ± 2.08 μg/g) disease activity compared with subjects with mild (1.51 μg/g ± 1.36 μg/g) disease activity (P < 0.05). GEE analysis suggests that this marker could be used to monitor the severity and course of gastrointestinal infections and may provide information for disease management.

CONCLUSION: Fecal lactoferrin increased during bacterial infection and with greater disease severity and may be a good marker for predicting and monitoring intestinal inflammation in children with infectious diarrhea.

Keywords: Lactoferrin, Diarrhea, Generalized estimating equations, Vesikari scores, Clark scores