EBV-DNA viral load and lymphocyte subsets correlation in pediatric infectious mononucleosis with hepatic injury a retrospective cohort study.

BACKGROUND

Infectious mononucleosis is often complicated by hepatic injury, in which Epstein-Barr virus load and immune response may play important roles.

OBJECTIVE

To investigate the correlation between EBV-DNA viral load and lymphocyte subsets in patients with IM with hepatic injury.

METHODS

A retrospective cohort study was conducted on children diagnosed with IM from January 2022 to August 2025. Patients were divided into hepatic injury group and non-hepatic injury group. EBV-DNA load, lymphocyte subsets (CD3+, CD4+, CD8+, CD19+, CD16+ CD56+) and liver function indicators were measured and analyzed.

RESULTS

Among 202 children, the hepatic injury group (n = 143) showed significantly higher EBV-DNA load (t = 4.844, P < 0.001), increased CD8+ T cell percentage (t = 7.235, P < 0.001), decreased CD4+/CD8+ ratio (t = 9.876, P < 0.001) and reduced NK cell percentage (t = 4.325, P < 0.001). Liver function tests revealed significantly elevated ALT, AST, GGT and TBil (t = 15.678, 13.456, 8.923, 7.234, P < 0.001), and decreased ALB (t = 5.678, P < 0.001) in the hepatic injury group. Correlation analysis showed positive correlation between EBV-DNA load and CD8+ T cell percentage (P < 0.001), and negative correlation with CD4+/CD8+ ratio (P < 0.001). Multivariate analysis identified high EBV-DNA load and elevated CD8+ T cell percentage as independent risk factors for hepatic injury (OR = 5.678, 1.456, P < 0.001).

CONCLUSION

Elevated EBV-DNA load and an increased CD8+ T cell percentage are independently associated with hepatic injury in pediatric IM. Monitoring these parameters may help in identifying children at higher risk for hepatic involvement, although prospective validation is required.