Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis
Background and Objectives: Co-infection with <i>Clostridioides difficile</i> (<i>C. difficile</i>) in COVID-19 patients has emerged as a clinical challenge associated with increased morbidity and mortality. While both infections elicit systemic inflammation, the interplay bet...
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2025-01-01
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| author | Flavia Ignuta Adrian Vlad Teodor Cerbulescu Stana Loredana Felix Bratosin Ovidiu Rosca Lavinia Stelea Daciana Nistor |
| author_facet | Flavia Ignuta Adrian Vlad Teodor Cerbulescu Stana Loredana Felix Bratosin Ovidiu Rosca Lavinia Stelea Daciana Nistor |
| author_sort | Flavia Ignuta |
| collection | DOAJ |
| description | Background and Objectives: Co-infection with <i>Clostridioides difficile</i> (<i>C. difficile</i>) in COVID-19 patients has emerged as a clinical challenge associated with increased morbidity and mortality. While both infections elicit systemic inflammation, the interplay between inflammatory markers, disease severity, and outcomes in patients with COVID-19 and concurrent <i>C. difficile</i> infection remains poorly characterized. This study aimed to evaluate the inflammatory status and clinical outcomes of patients hospitalized with COVID-19, with and without <i>C. difficile</i> co-infection, and to identify the inflammatory markers most predictive of severe disease. Methods: We conducted a retrospective cohort study of 200 hospitalized adults with confirmed COVID-19, of whom 92 had laboratory-confirmed <i>C. difficile</i> infection. Baseline demographic data, comorbidities, inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6], ferritin, neutrophil-to-lymphocyte ratio [NLR], platelet count, albumin, and derived indices such as the CRP-to-Albumin Ratio [CAR] and Prognostic Nutritional Index [PNI]) were recorded. Clinical outcomes included ICU admission, need for mechanical ventilation, length of stay, and in-hospital mortality. Results: Patients with COVID-19 and <i>C. difficile</i> co-infection had significantly elevated inflammatory markers (CRP, IL-6, NLR) and higher CAR, alongside lower PNI, compared to those with COVID-19 alone (<i>p</i> < 0.001). Inflammatory indices correlated strongly with disease severity: elevated CAR and low PNI were associated with higher odds of ICU admission and mortality (<i>p</i> < 0.001). Multivariate analysis identified co-infection status, increased IL-6, and elevated CAR as independent predictors of severe outcomes. Conclusions: <i>C. difficile</i> co-infection in COVID-19 patients is associated with an intensified inflammatory response and worse clinical outcomes. Among the evaluated markers, CAR and PNI emerged as robust predictors of severe disease. Timely recognition of <i>C. difficile</i> co-infection and use of targeted anti-inflammatory and supportive therapies may improve patient management. Future studies should expand on these findings to optimize care and guide therapeutic strategies. |
| format | Article |
| id | doaj-art-865be7ab1fa5475da726b6ac88818a3e |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| series | Biomedicines |
| spelling | doaj-art-865be7ab1fa5475da726b6ac88818a3e2025-01-24T13:24:03ZengMDPI AGBiomedicines2227-90592025-01-0113111110.3390/biomedicines13010111Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort AnalysisFlavia Ignuta0Adrian Vlad1Teodor Cerbulescu2Stana Loredana3Felix Bratosin4Ovidiu Rosca5Lavinia Stelea6Daciana Nistor7Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment III—Microscopic Morphology, Discipline of Cellular and Molecular Biology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment I, Discipline of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDiscipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDepartment of Functional Sciences, Physiology, Centre of Imuno-Physiology and Biotechnologies (CIFBIOTEH), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaBackground and Objectives: Co-infection with <i>Clostridioides difficile</i> (<i>C. difficile</i>) in COVID-19 patients has emerged as a clinical challenge associated with increased morbidity and mortality. While both infections elicit systemic inflammation, the interplay between inflammatory markers, disease severity, and outcomes in patients with COVID-19 and concurrent <i>C. difficile</i> infection remains poorly characterized. This study aimed to evaluate the inflammatory status and clinical outcomes of patients hospitalized with COVID-19, with and without <i>C. difficile</i> co-infection, and to identify the inflammatory markers most predictive of severe disease. Methods: We conducted a retrospective cohort study of 200 hospitalized adults with confirmed COVID-19, of whom 92 had laboratory-confirmed <i>C. difficile</i> infection. Baseline demographic data, comorbidities, inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6], ferritin, neutrophil-to-lymphocyte ratio [NLR], platelet count, albumin, and derived indices such as the CRP-to-Albumin Ratio [CAR] and Prognostic Nutritional Index [PNI]) were recorded. Clinical outcomes included ICU admission, need for mechanical ventilation, length of stay, and in-hospital mortality. Results: Patients with COVID-19 and <i>C. difficile</i> co-infection had significantly elevated inflammatory markers (CRP, IL-6, NLR) and higher CAR, alongside lower PNI, compared to those with COVID-19 alone (<i>p</i> < 0.001). Inflammatory indices correlated strongly with disease severity: elevated CAR and low PNI were associated with higher odds of ICU admission and mortality (<i>p</i> < 0.001). Multivariate analysis identified co-infection status, increased IL-6, and elevated CAR as independent predictors of severe outcomes. Conclusions: <i>C. difficile</i> co-infection in COVID-19 patients is associated with an intensified inflammatory response and worse clinical outcomes. Among the evaluated markers, CAR and PNI emerged as robust predictors of severe disease. Timely recognition of <i>C. difficile</i> co-infection and use of targeted anti-inflammatory and supportive therapies may improve patient management. Future studies should expand on these findings to optimize care and guide therapeutic strategies.https://www.mdpi.com/2227-9059/13/1/111systemic inflammationco-infectioninflammatory markersclinical outcomespredictive biomarkers |
| spellingShingle | Flavia Ignuta Adrian Vlad Teodor Cerbulescu Stana Loredana Felix Bratosin Ovidiu Rosca Lavinia Stelea Daciana Nistor Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis Biomedicines systemic inflammation co-infection inflammatory markers clinical outcomes predictive biomarkers |
| title | Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis |
| title_full | Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis |
| title_fullStr | Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis |
| title_full_unstemmed | Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis |
| title_short | Evaluation of Inflammatory Markers and Clinical Outcomes in COVID-19 Patients with Concurrent <i>Clostridioides difficile</i> Infection: A Comparative Cohort Analysis |
| title_sort | evaluation of inflammatory markers and clinical outcomes in covid 19 patients with concurrent i clostridioides difficile i infection a comparative cohort analysis |
| topic | systemic inflammation co-infection inflammatory markers clinical outcomes predictive biomarkers |
| url | https://www.mdpi.com/2227-9059/13/1/111 |
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