PROTEIN-LOSING ENTEROPATHY IS ASSOCIATED WITH CLOSTRIDIUM-DIFFICILE DIARRHEA BUT NOT WITH ASYMPTOMATIC COLONIZATION - A PROSPECTIVE, CASE-CONTROL STUDY

A prospective, case-control study was performed in which enteric prote in loss and nutritional status were measured in patients with symptoma tic and asymptomatic infections due to Clostridium difficile. Enteric protein loss, measured by elevated levels of fecal alpha(1)-antitrypsi n, was detected in 14 of 20 cases and controls with diarrhea (9 of 10 cases with C. difficile-associated diarrhea and 5 of 10 age-matched co ntrols with diarrhea not associated with C. difficile) compared with n one of 20 asymptomatic cases and controls (10 colonized cases and 10 n oncolonized controls without diarrhea who were matched by age and clin ical diagnosis) (P < .0001). Cases and controls with diarrhea had high er prognostic nutritional index values (P = 0.005) and tower levels of serum albumin, transferrin, and cholesterol than did the asymptomatic cases and controls. Decreased nutritional status, measured by increas ed prognostic nutritional index values, was associated with the presen ce of diarrhea but not with the presence of C. difficile. Protein-losi ng enteropathy was associated with C. difficile only in the presence o f diarrhea, and we did not detect an increased risk of protein-losing enteropathy or malnutrition as a consequence of asymptomatic colonizat ion with C. difficile.