Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea

Table 1 Patient characteristics

Gender
Female	52
Male	65
Age (mean), yr	3.23 (3 mo-10 yr)
Pathogen identified
Rotavirus	41
Norovirus	28
Salmonella	31
Campylobacter	17
Disease severity (Vesikari scoring scale)
Mild	42
Moderate	50
Severe	25
Duration of diarrhea (median), h	73.8 (14-169)
Vomiting, (d)	2.1 (0-5)
Fever, (d)	2.9 (0-7)
WBC counts (106/L)	12 658 ± 2364
CRP (mg/L)	34.7 ± 22.1
Hemoglobin (g/dL, n = 117)	11.6 (8.2-15.3)
Platelets (109/L, n = 117)	232 (134-585)

Range in brackets. WBC: White blood cells; CRP: C-reactive protein.

Table 2 The Vesikari and Clark severity scoring scales for the evaluation of gastroenteritis in children

Severity scoring scales	Point value
	1	2	3
Vesikari[5]
Duration of diarrhea (d)	1-4	5	≥ 6
Maximum number of diarrhea stools/24 h	1-3	4-5	≥ 6
Duration of vomiting (d)	1	2	≥ 3
Maximum number of vomiting episodes/24 h	1	2-4	≥ 5
Temperature (°C)	37.1-38.4	38.5-38.9	≥ 39.0
Dehydration	-	Mild	Moderate to severe
Treatment	Rehydration	Hospitalization	-
Clark[6]
Diarrhea
Number of stools/d	2-4	5-7	≥ 8
Duration in days	1-4	5-7	≥ 8
Vomiting
Number of emeses/d	1-3	4-6	≥ 7
Duration in days	2	3-5	≥ 6
Rectal temperature
Temperature (°C)	38.1-38.2	38.3-38.7	≥ 38.8
Duration in days	1-2	3-4	≥ 5
Behavioral symptoms/signs
Description	Irritable/less playful	Lethargic/listless	Seizure
Duration in days	1-2	3-4	≥ 5

Table 3 Univariate linear regression outcome: Lactoferrin (y = α + βx)

	β	Standard error	95% CI		P value
			Lower	Upper
WBC	-0.05	0.10	-0.25	0.14	0.581
Segment	0.00	0.02	-0.05	0.05	0.941
Band	0.47	0.27	-0.07	1.01	0.089
CRP	0.02	0.01	0.00	0.04	0.043a
Fecal pus cell
None	0.00
Present	0.38	1.55	-2.74	3.49	0.809
Fecal occult blood
None	0.00
Present	1.71	1.22	-0.73	4.15	0.165
Fecal mucus
None	0.00
Positive	-2.21	1.46	-5.14	0.71	0.135
Vesikari scoring scale
Non-severe < 11	0.00
Moderate ≥ 11	2.76		-1.50	7.02	0.191
Severe ≥ 16	2.81	1.13	0.56	5.07	0.015a
Clark scoring scale
Non-severe < 16	0.00
Severe ≥ 16	3.13	1.10	0.93	5.32	0.006a
Body temperature	0.29	0.30	-0.31	0.89	0.341
Abdominal pain	0.88	0.63	-0.39	2.15	0.169
Abdominal distension	-0.30	1.01	-2.32	1.71	0.764
Dehydration	3.13	1.38	0.37	5.89	0.027a
Oral intake	1.13	1.23	-1.33	3.59	0.362
Activity	1.13	1.00	-0.87	3.13	0.262
Fever day	0.09	0.28	-0.46	0.65	0.739
Diarrhea day	0.41	0.29	-0.60	1.41	0.423
Vomiting day	-0.99	0.53	-1.93	-0.04	0.041a

^aP < 0.05. WBC: White blood cells; Band: Band form neutrophil; CRP: C-reactive protein.

Table 4 Generalized estimating equations analysis for series follow-up of fecal lactoferrin

Parameter	Estimate	Standarderror	95% confidence interval		P value
Clark score
Intercept	5.1523	0.7490	3.6843	6.6202	< 0.0001a
Clark score	2.0393	1.7397	-1.3704	5.4489	0.2411
Time	-0.3729	0.2530	-0.8688	0.123	0.1405
Time x Clark	0.5826	0.8342	-1.0525	2.2177	0.485
Vesikari score
Intercept	3.9289	0.8437	2.2752	5.5825	< 0.0001a
Vesikari score	3.2257	1.3018	0.6741	5.7773	0.0132a
Time	-0.1835	0.2715	-0.7157	0.3487	0.4992
Time x Vesikari	-0.1575	0.5222	-1.1811	0.8660	0.0429a
Band (band form neutrophil)
Intercept	3.6654	1.0750	1.5585	5.7723	0.0007a
Band	1.9759	0.6951	0.6135	3.3383	0.0045a
Time	1.6270	0.8206	0.0186	3.2354	0.0474a
Band x time	-1.5261	0.4677	-2.4428	-0.6094	0.0011a

^aP < 0.05.