{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T22:00:49Z","timestamp":1792706449422,"version":"4.5.0"},"reference-count":23,"publisher":"Microbiology Society","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,9,1]]},"abstract":"<jats:p>Host anti-toxin immune responses play important roles in <jats:italic>Clostridium difficile<\/jats:italic> disease and outcome. The relationship between host immune and inflammatory responses during severe <jats:italic>C. difficile<\/jats:italic> infection (CDI) and the risk of mortality has yet to be defined. We aimed to investigate the host systemic IgG anti-toxin immune responses, the <jats:italic>in vitro<\/jats:italic> cytotoxicity of the infecting <jats:italic>C. difficile<\/jats:italic> ribotyped strain, and the host inflammatory markers and their relationship to CDI disease severity and risk of mortality. Inflammatory markers, co-morbidities and CDI outcomes were recorded in a prospective cohort of 150 CDI cases. Serum anti-cytotoxin A (TcdA) and anti-TcdB IgG titres were measured by ELISA and the infecting <jats:italic>C. difficile<\/jats:italic> isolate was ribotyped and the <jats:italic>in vitro<\/jats:italic> cytotoxin titre assessed. A low median anti-TcdA IgG titre was significantly associated with 30-day all-cause mortality (<jats:italic>P<\/jats:italic>&lt;0.05). Ribotype 027 isolates were significantly more toxinogenic than other ribotypes (<jats:italic>P<\/jats:italic>&lt;0.00001). High cytotoxin titres correlated with increased inflammatory markers but also higher anti-TcdA and -TcdB (<jats:italic>P<\/jats:italic>&lt;0.05) IgG responses resulting in a lower risk of mortality. On multivariate analysis, predictors of mortality were peak white cell count &gt;20\u00d710<jats:sup>9<\/jats:sup> l<jats:sup>\u22121<\/jats:sup> [odds ratio (OR) 11.53; 95\u200a% confidence interval (CI) 2.38\u201355.92], creatinine concentration &gt;133 \u00b5mol l<jats:sup>\u22121<\/jats:sup> (OR 6.54; 95\u200a% CI 1.47\u201329.07), Horn\u2019s index &gt;3 (OR 4.09; 95\u200a% CI 0.76\u201322.18) and low anti-TcdA IgG (OR 0.97; 95\u200a% CI 0.95\u20130.99), but not ribotype, cytotoxin titre or anti-TcdB IgG. Thus, host pro-inflammatory and humoral responses correlate with the cytotoxin titre of the infecting strain and effective anti-toxin immune responses reduce the risk of mortality.<\/jats:p>","DOI":"10.1099\/jmm.0.058479-0","type":"journal-article","created":{"date-parts":[[2013,5,31]],"date-time":"2013-05-31T01:30:14Z","timestamp":1369963814000},"page":"1453-1460","source":"Crossref","is-referenced-by-count":77,"title":["Mortality in patients with Clostridium difficile infection correlates with host pro-inflammatory and humoral immune responses"],"prefix":"10.1099","volume":"62","author":[{"given":"Katie","family":"Solomon","sequence":"first","affiliation":[{"name":"School of Medicine and Medical Science, UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caoilfhionn","family":"O\u2019Donoghue","sequence":"additional","affiliation":[{"name":"Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhua","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda","family":"Fenelon","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, St Vincent\u2019s University Hospital, Elm Park, Dublin 4, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9amus","family":"Fanning","sequence":"additional","affiliation":[{"name":"School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin 4, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciar\u00e1n P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Kyne","sequence":"additional","affiliation":[{"name":"Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland"},{"name":"School of Medicine and Medical Science, UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, 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