Evaluation of the CD4/CD8 Ratio as a Predictor for the Severity of Postoperative Infection in Children with Orthopedic Fracture Surgery | ||
| International Journal of Medical Arts | ||
| Articles in Press, Accepted Manuscript, Available Online from 01 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ijma.2025.409497.2237 | ||
| Authors | ||
| Ahmed Mohamed Noshy* 1; Magdy zaky El-Ghannam2; Mahmoud Farag Salem2; Mahmoud Mohamed El Said3; Dina Ahmed Elbayaa4 | ||
| 1Clinical pathology department, alazhar university, Damietta | ||
| 2Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University | ||
| 3Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University | ||
| 4Department of Pediatrics, Faculty of Medicine, Port Said University, Port Said, Egypt. | ||
| Abstract | ||
| Background: Postoperative infections remain a significant complication in pediatric orthopedic surgery, particularly in fracture management. Early detection of patients at high risk can facilitate prompt intervention and improved outcomes. The CD4/CD8 T-cell ratio is a potential immunological marker for predicting infection susceptibility and severity. Objective: To evaluate the diagnostic value of the CD4/CD8 ratio as a predictor of postoperative infection and its severity in children undergoing orthopedic fracture surgery. Methods: This cross-sectional study included 64 pediatric patients (aged 6–16 years) who underwent orthopedic fracture surgery at Al-Azhar University Hospital – New Damietta. Patients were monitored for 14 days postoperatively for signs of sepsis. Exclusion criteria included polytrauma, open wounds, immunological or chronic diseases. All patients underwent clinical assessment and laboratory investigations, including CBC, CRP, and flow cytometry for CD4 and CD8 T-cell markers. Patients were classified as infected or non-infected, and severity of infection was further categorized into mild (A), moderate (B), or severe (C). Results: Postoperative infection occurred in 31.3% of patients. Infected patients had significantly lower CD4% (mean 30.4% vs. 50.1%, p<0.001), higher CD8% (mean 43.5% vs. 29.5%, p<0.001), and markedly reduced CD4/CD8 ratios (mean 0.66 vs. 1.78, p<0.001) compared to non-infected patients. The CD4/CD8 ratio showed perfect diagnostic accuracy (AUC = 1.0), with a cutoff value ≤0.9 yielding 100% sensitivity, specificity, PPV, and NPV. Severity analysis revealed a progressive decline in CD4/CD8 ratio with increased infection severity (p<0.001). Conclusion: The CD4/CD8 ratio is a highly sensitive and specific immunological marker for predicting postoperative infection and its severity in pediatric orthopedic fracture surgery. Routine immunophenotyping may enhance risk stratification and early management in these patients. | ||
| Keywords | ||
| CD4/CD8 ratio; pediatric orthopedic surgery; postoperative infection; infection severity | ||
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