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

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 al 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. 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. 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. 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.