Neutrophil Ratio of White Blood Cells as a Prognostic Predictor of Clostridioides difficile Infection

Abstract

Ching-Chi Lee,1,2,* Jen-Chieh Lee,2,* Chun-Wei Chiu,3 Pei-Jane Tsai,4– 6 Wen-Chien Ko,2,7 Yuan-Pin Hung2,3,7 1Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 2Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 3Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, 700, Taiwan; 4Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 5Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Centers of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; 7Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan*These authors contributed equally to this workCorrespondence: Yuan-Pin Hung, Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, 700, Taiwan, Email [email protected] Wen-Chien Ko, Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan, Email [email protected]: A leukocyte count ≥ 15,000 cells/mL and serum creatinine of > 1.5 mg/dL have been reported as two important predictors of severe CDI. However, the association of the differential ratios of blood leukocytes, and the prognosis of Clostridioides difficile infection (CDI) is not clear.Materials and Methods: A clinical study was conducted at medical wards of Tainan Hospital, Ministry of Health and Welfare in southern Taiwan between January 2013 and April 2020. Hospitalized adults (aged ≥ 20 years) with hospital-onset CDI (ie, symptom onset after at least 48 hours of admission) were included.Results: A total of 235 adults with an average age of 75.7 years and female predominance (51.5%), including 146 (62%) adults with non-severe CDI and 87 (38%) severe CDI, were included for analysis. Patients with severe CDI had a higher crude in-hospital mortality rate than patients with non-severe CDI (35.6% vs 18.5%, P = 0.005). Multivariate analysis revealed no association between a leukocyte count > 15,000 cell/mL at the onset of CDI and in-hospital mortality (odds ratio [OR] 1.66, P = 0.21). In contrast, a neutrophil ratio > 75% (OR 2.65, P = 0.02), serum creatinine > 1.5 mg/L (OR 3.42, P = 0.03), and CDI caused by isolates harboring the tcdC gene (OR 3.54, P = 0.02) were independently associated with in-hospital mortality. Patients with a neutrophil ratio > 85%, 80– 85%, or 75– 80% of serum leukocytes had a higher mortality rate (34.8%, 30.3%, or 34.4%, respectively) than patients with a neutrophil ratio of 70– 75% or ≤ 75% (12.5% or 13.9%, respectively).Conclusion: Serum creatinine > 1.5 mg/L, a high neutrophil ratio of blood leukocytes (> 75%), and the causative C. difficile harboring the tcdC gene was independent prognostic predictors in hospitalized adults with CDI.Keywords: Clostridioides difficile, leukocyte, differential ratio, neutrophil, prognosis, mortality

Keywords

• clostridioides difficile
• leukocyte
• differential ratio
• neutrophil
• prognosis
• mortality.