Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea
Jae Sung Ahn, Seung In Seo, Jinseob Kim, Taewan Kim, Jin Gu Kang, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim
Jae Sung Ahn, Taewan Kim, Jin Gu Kang, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
Seung In Seo, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
Seung In Seo, Hyoung Su Kim, Woon Geon Shin, Myoung Kuk Jang, Hak Yang Kim, Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
Jinseob Kim, Department of Epidemiology, School of Public Health, Seoul National University, Seoul KS013, South Korea
Author contributions: Seo SI designed the research study; Ahn JS and Seo SI performed the research; Kim JS contributed statistical analysis; Seo SI, Kim TW, Kang JG and Kim HS analyzed the data; Shin WG, Jang MK and Kim HY provided material support; Seo SI and Ahn JS wrote the manuscript. All authors have read and approve the final manuscript.
Supported by Kangdong Sacred Heart Hospital Fund, No. 2017-07.
Institutional review board statement: The protocol for this study was approved by the institutional review board of Kangdong Sacred Heart Hospital, No. 2020-02-008.
Informed consent statement: We received exemption of informed consent.
Conflict-of-interest statement: All authors have no any conflicts of interest.
Data sharing statement: No additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seung In Seo, MD, Assistant Professor, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445, Gil-dong, Kangdong-gu, Seoul KS013, South Korea. doctorssi@kdh.or.kr
Received: March 11, 2020
Peer-review started: March 11, 2020
First decision: April 25, 2020
Revised: June 4, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 6, 2020
ARTICLE HIGHLIGHTS
Research background
Stool multiplex polymerase chain reaction (PCR) assay has been suggested to be highly specific and sensitive compared to conventional methods. Thus, its efficacy should be evaluated in clinical practice. Further, the efficacy of fecal calprotectin in acute infectious diarrhea has not been elucidated in adults.
Research motivation
Several studies have investigated the efficacy of stool multiplex PCR assay and calprotectin test in children with acute infectious diarrhea. However, studies on adult patients are limited.
Research objectives
We aimed to evaluate the efficacy of stool multiplex PCR test and fecal calprotectin expression in adult patients with acute infectious diarrhea.
Research methods
We reviewed clinical and laboratory findings and compared the clinical characteristics according to the positivity of stool PCR. We performed a multivariate logistic regression analysis to determine the factors predicting positivity of stool PCR. Using ROC analysis, we evaluated the diagnostic efficacy of calprotectin expression in detecting bacterial pathogens by stool PCR.
Research results
Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture (49.2% vs 5.2%), with Campylobacter as the most common pathogen (54%). C-reactive protein (CRP) (OR = 1.01, 95%CI: 1.001-1.027, P = 0.034) and sigmoidoscopy-detected colitis (OR = 4.76, 95%CI: 1.101-20.551, P = 0.037) were independent factors in stool PCR-based detection of bacterial pathogens. Sensitivity and specificity of calprotectin were evaluated to be 70.5% and 60.9%, respectively (adjusted cut-off value = 388 mg/kg).
Research conclusions
Stool multiplex PCR test showed improved sensitivity than conventional culture method in detecting bacterial pathogens in hospitalized patients with acute infectious diarrhea. Patients with positive stool PCR showed higher CRP expression level and colitis on sigmoidoscopy. Fecal calprotectin was found to correlate with the positivity of stool PCR, and the adjusted cut-off value of calprotectin for detecting bacterial pathogens by stool PCR was found to be 388 mg/kg.
Research perspectives
We suggest that stool multiplex PCR and calprotectin test may improve the diagnosis of acute infectious diarrhea in adults. Future prospective studies are warranted.
