TIBC, PLR, and EBV DNA load correlate with hepatic injury in EBV-associated infectious mononucleosis

To analyze clinical features of hepatic injury in children with EBV-associated infectious mononucleosis (EBV-IM) and identify its risk factors.

A retrospective analysis of the clinical data of children with EBV-IM admitted to the First Hospital of Jilin University from March 2023 to March 2025 was conducted. Confounding factors were balanced by propensity score matching (PSM). The children were divided into a hepatic injury group and a non-hepatic injury group. The risk factors were examined using binary logistic regression. Furthermore, the diagnostic performance of these risk factors was assessed and presented using receiver operating characteristic (ROC) curves.

After PSM, 52 pairs of patients were matched. Statistically significant differences in white blood cell count, the proportion of neutrophils, the proportion and absolute value of lymphocytes, the platelet-to-lymphocyte ratio (PLR), hepatosplenomegaly, whole blood EBV DNA load >1 × 10⁵ copies/mL, and total iron-binding capacity(TIBC) were detected(all P < 0.05). Multivariate logistic regression analysis revealed that TIBC and whole blood EBV DNA load >1 × 10⁵ copies/mL were risk factors, whereas the PLR was a protective factor. ROC curve analysis showed that the cutoff values of TIBC and reciprocal platelet-to-lymphocyte ratio (rPLR) for the diagnosis of EBV-IM-related hepatic injury were 53.250 μmol/L and 0.052, with areas under the curve of 0.652 and 0.713, sensitivities of 69.2% and 53.8%, and specificities of 62.7% and 88.2%, and these two indicators could be used as diagnostic markers for hepatic injury in children with EBV-IM.

EBV-IM-related hepatic injury in children correlates with iron metabolism. TIBC and whole blood EBV DNA load (>1 × 10⁵ copies/mL) are independent risk factors, whereas the PLR is a protective factor.