Temporal changes in serum albumin and total protein in patients with hospital-acquired Clostridium difficile infection.

Studies have demonstrated low serum levels of total protein (TP) and albumin (ALB) in patients with Clostridium difficile infection (CDI), especially with refractory and recurrent disease. However, it is not known whether low TP and/or ALB levels are a risk factor for CDI or merely a result of diarrheal loss. The aim of this study is to determine if low TP and/or ALB level is an antecedent or sequela of CDI, which would be useful in risk stratification of hospitalized or nursing home patients. A retrospective cohort study was conducted in a 700-bed tertiary care teaching hospital. Records of all hospitalized patients with CDI from 2006-2011 were analyzed. The inclusion criteria for the final cohort (n=46) were: subjects not diagnosed with HIV; onset of CDI at least one week after hospitalization; serial values of TP and ALB available on three occasions (at onset of CDI, seven days prior, and post-onset of CDI). Seven days prior to the onset of CDI, 40/46 (87%) subjects had low ALB levels with a mean of 2.6±0.7 g/dL and 37/46 (80.4%) had low TP with a mean of 5.8±1.0 g/dL. At the onset of CDI, 45/46 (97.8%) subjects had low ALB (group: 2.1±0.6 g/dL) and 41/46 (89.1%) had low TP (group: 5.1±1.0). Seven days post-onset of CDI, 45/46 subjects continued to have decreased ALB (group: 2.0±0.6) and 39/46 (84.8%) had low TP (group: 5.2±1.2). The pre-onset data for ALB and TP were significantly different than the comparable data at onset and seven days post-onset (p<0.0001 for both ALB and TP). No significant difference was observed between onset and seven days post-onset. Most patients are hypoproteinemic prior to the onset of hospital-acquired CDI. Although some subjects lost protein after the onset of CDI, this was not statistically significant. This study suggests that antecedent low levels of ALB and TP may be a risk factor for the acquisition of CDI.