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We propose redefining severe disease using these three criteria to guide therapy. We recommend using only an elevated WBC and hypoalbuminemia (as opposed to serum creatinine) because these values are relatively straightforward to use clinically. Furthermore, WBC and albumin values are directly linked to the pathogenesis of CDI; TcdA is a potent neutrophil chemoattractant that can result in increasing serum WBC counts.
Hypoalbuminemia may correlate with severity of diarrhea because it results in a protein-losing enteropathy and albumin is considered a negative acute phase protein and a marker of inflammatory states.