Predictive value of preoperative T cell phenotypes for postoperative pulmonary complications in elderly patients undergoing thoracic surgery.

BACKGROUND

Postoperative pulmonary complications (PPCs) significantly impair patient recovery, yet reliable predictors remain scarce. T cell and mitochondrial phenotypic marker abnormalities are recognized as key mechanisms underlying immune dysregulation. Accordingly, we hypothesized that quantifying these T cell characteristics could serve as a novel predictive strategy for PPCs.

METHODS

Patients who underwent elective thoracic surgery under general anesthesia were enrolled in this study. Preoperative venous blood samples were collected to measure T cell subsets and their mitochondrial function indicators.

RESULTS

The occurrence of PPCs was evaluated postoperatively. Among the 176 enrolled patients, 44 (25.0%) developed PPCs. Compared with the non-PPCs group, patients in the PPCs group were older, had longer operative time, and exhibited significantly higher preoperative levels of C-reactive protein, neutrophils, white blood cells, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, D-dimer, and international normalized ratio, while the preoperative lymphocyte percentage was significantly lower (P < 0.05). Regarding T cell related parameters, the PPCs group showed a significantly lower absolute count of CD3+CD4+ T cells, significantly higher percentage and absolute count of CD3+CD4+PD-1+ T cells, and a significantly lower percentage of CD3+CD8+MMP T cells (P < 0.05). Multivariable logistic regression analysis identified the percentage of CD3+CD4+PD-1+ T cells, absolute count of CD3+CD4+PD-1+ T cells, and operative time as independent risk factors for PPCs, while lymphocyte percentage emerged as an independent protective factor. After adjustment using different models, the multivariable model (Model 3) demonstrated that both the percentage and absolute count of CD3+CD4+PD-1+ T cells had good predictive performance for PPCs (P < 0.001).

CONCLUSIONS

Thus, preoperative measurement of T cell subsets indicators may aid in early identification and risk stratification of PPCs after thoracic surgery.