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A Potential Cellular Explanation for the Increased Risk of Clostridium difficile Infection Due to Hypoalbuminemia: Reply Di Bella et al

Published online by Cambridge University Press:  12 October 2015

Ying P. Tabak,
Richard S. Johannes and
L. Clifford McDonald
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Type
Letters to the Editor
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 12 , December 2015, pp. 1480
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

To the Editor—In their intriguing investigation, reported in “The protective role of albumin in Clostridium difficile infection: A step toward solving the puzzle,” Di Bella et alReference Di Bella, di Masi and Turla 1 explored the cellular mechanism of the potential protective effect of albumin in C. difficile infection (CDI). Their findings deepen our understanding of the association between low albumin levels and increased risks for CDI.Reference Tabak, Johannes, Sun, Nunez and McDonald 2 We applaud their effort.

Previous epidemiological work has revealed that hypoalbuminemia is a robust independent risk factor for mortality for hospitalized patients across a spectrum of clinical categories.Reference Khuri, Daley and Henderson 3 – Reference Tabak, Sun, Nunez and Johannes 5 Our most recent CDI predictive model demonstrated that hypoalbuminemia is one of the independent risk factors that are associated with, or predictive of, hospital-onset CDI.Reference Di Bella, di Masi and Turla 1 The study by Di Bella et al demonstrates that at the cellular level hypoalbuminemia plays a role in the predisposition to CDI, due to compromising the protective properties of albumin. Future studies may further explore the mechanism of low albumin levels and other pathological manifestations.

ACKNOWLEDGMENT

Potential conflicts of interest: Y.P.T. and R.S.J. are employees of CareFusion. L.C.M. reports no conflicts of interest relevant to this article.

Financial support: No grant support or writing assistance was provided for this work.

References

REFERENCES

1. Di Bella, S, di Masi, A, Turla, S, et al. The Protective Role of Albumin in Clostridium difficile Infection: A Step Toward Solving the Puzzle. Infect Control Hosp Epidemiol 2015; doi 10.1017/ice.2015.221.Google Scholar
2. Tabak, YP, Johannes, RS, Sun, X, Nunez, CM, McDonald, LC. Predicting the risk for hospital-onset Clostridium difficile infection (HO-CDI) at the time of inpatient admission: HO-CDI risk score. Infect Control Hosp Epidemiol 2015;36:695–701.Google Scholar
3. Khuri, SF, Daley, J, Henderson, W, et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997;185:315–327.Google Scholar
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5. Tabak, YP, Sun, X, Nunez, CM, Johannes, RS. Using electronic health record data to develop inpatient mortality predictive model: Acute Laboratory Risk of Mortality Score (ALaRMS). J Am Med Inform Assoc 2014;21:455–463.Google Scholar