Fecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children

J Pediatr Gastroenterol Nutr. 2012 Nov;55(5):541-7. doi: 10.1097/MPG.0b013e318262a718.


Background: Calprotectin is a marker associated with intestinal inflammation. The aim of this study is to explore the diagnostic value of fecal calprotectin in predicting bacterial/viral diarrhea and the application of fecal calprotectin in the clinical course of infectious diarrhea.

Methods: Patients ages from 3 months to 10 years with infectious diarrhea were enrolled, and from each patient, 2 to 3 stool samples were collected. Fecal calprotectin levels were determined by enzyme-linked immunosorbent assay and compared by pathogen and disease activity. A univariate linear regression was used to determine the correlation between fecal calprotectin and the clinical parameters, and generalized estimating equations (GEEs) were used for the time course analyses.

Results: The data include 451 evaluations for 153 individuals across 3 different time points. The fecal calprotectin level was higher in patients with Salmonella infection (median with range 765 [252-1246] μg/g) or Campylobacter infection (689 [307-1046] μg/g) compared with patients with rotavirus infection (89 [11-426] μg/g), norovirus infection (93 [25-405] μg/g), or adenovirus infection (95 [65-224] μg/g). Fecal calprotectin concentrations were elevated in patients with severe (843 [284-1246] μg/g) or moderate (402 [71-995] μg/g) disease activity compared with those with mild (87 [11-438] μg/g) disease activity (P < 0.05). GEE analysis suggests that fecal calprotectin is correlated with clinical severity (e.g., Vesikari score) and may provide information for disease management.

Conclusions: Fecal calprotectin levels increased during bacterial infection and as disease severity increased, and its levels on the initial evaluation and follow-up visit are correlated with clinical severity. Fecal calprotectin may be a useful marker for application in children during infectious diarrhea.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoviridae
  • Biomarkers / metabolism
  • Campylobacter
  • Child
  • Child, Preschool
  • Diarrhea / metabolism*
  • Diarrhea / microbiology
  • Diarrhea / virology
  • Enzyme-Linked Immunosorbent Assay
  • Feces / chemistry*
  • Female
  • Humans
  • Infant
  • Infections / metabolism*
  • Infections / microbiology
  • Infections / virology
  • Inflammatory Bowel Diseases / metabolism*
  • Inflammatory Bowel Diseases / microbiology
  • Inflammatory Bowel Diseases / virology
  • Intestinal Mucosa / metabolism*
  • Intestines / microbiology
  • Intestines / virology
  • Leukocyte L1 Antigen Complex / metabolism*
  • Linear Models
  • Male
  • Norovirus
  • Rotavirus
  • Salmonella
  • Severity of Illness Index*


  • Biomarkers
  • Leukocyte L1 Antigen Complex