BACKGROUND: To investigate the clinical features and risk factors of severe Epstein-Barr virus (EBV) infection in children. METHODS: A retrospective analysis of the medical records of 144 cases admitted to the PICU (Pediatric Intensive Care Unit) and pediatric general wards of Shanghai Children's Hospital from January 2019 to March 2024 for Epstein-Barr virus (EBV) infection was conducted. The cases were categorized into severe and IM (Infectious Mononucleosis) groups according to the presence or absence of organ dysfunction. RESULTS: The children in the severe group exhibited elevated incidences of gastrointestinal symptoms, cervical lymph node enlargement, hepatomegaly, and gallbladder and bile duct involvement (P ≤ 0.05). The plasma EBV DNA copy number of children in the severe group was higher than that in the IM group. Additionally, hemoglobin levels, D-dimer levels, lymphocyte subsets, and cytokines IL (Interleukin)-10 and IFN (Interferon)-γ were statistically different between the two groups (all P ≤ 0.05). Independent risk factors for severe EBV infection were identified as hemoglobin, IFN-γ and D-dimer. The predicted AUC (Area Under Curve) for hemoglobin was 0.83, with a critical value of 11.1 g/dL (P = 0.02); for D-dimer, the AUC was 0.93, with a critical value of 2.4 mg/L (P = 0.04); and for IFN-γ, the AUC was 0.80, with a critical value of 243.7 pg/ml (P = 0.04). CONCLUSION: This study suggests that hemoglobin, IFN-γ and D-dimer may are risk factors for progression of EBV infection to severe disease.
Tang et al. (2026) studied this question.