Lower peripheral T- and NK-cell counts are associated with systemic inflammation and nutritional status in hospitalized gastrointestinal surgery patients
5 affiliations
- 1Department of Pathology, The First Hospital of Changsha/The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- 2Changsha High-Throughput Sequencing Technology Innovation Center for Gastrointestinal Tumor Precision Medicine, Changsha, Hunan, China
- 3Department of Infectious and Immunology, The First Hospital of Changsha/The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- 4Department of Information and Data, The First Hospital of Changsha/The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- 5Department of Emergency, The First Hospital of Changsha/The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
Abstract
Background: Systemic inflammation and impaired nutritional status may be associated with altered cellular immune profiles in surgical inpatients. However, peripheral T- and NK-cell profiles and their clinical correlates remain insufficiently characterized in hospitalized gastrointestinal surgery patients.
Methods: This retrospective observational study included hospitalized patients from a gastrointestinal surgery department who underwent peripheral blood lymphocyte subset testing between January 2024 and May 2025. Patients were classified into disease categories according to discharge diagnoses. T lymphocytes, natural killer (NK) cells, B lymphocytes, and NKT cells were analyzed together with inflammatory markers, including interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and nutritional markers including serum albumin and hemoglobin. Group comparisons, correlation analyses, and multivariable regression were performed. Continuous T-cell and NK-cell counts were the primary outcomes; cohort-defined low-count status was a secondary exploratory outcome. Sensitivity analyses included multiple imputation and Firth penalized logistic regression.
Results: After excluding one patient with missing diagnosis, 887 patients were included, of whom 623 had complete data for multivariable analysis. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with lower continuous T-cell and NK-cell counts and higher odds of low-count status across complete-case and sensitivity analyses. In models pooled across 50 imputed datasets, obstruction/perforation-related acute abdomen, compared with benign anorectal diseases, was associated with lower T-cell counts (adjusted geometric mean ratio [aGMR] = 0.822, 95% CI 0.706–0.958, P = 0.012) and lower NK-cell counts (aGMR = 0.821, 95% CI 0.677–0.995, P = 0.045). These associations did not reach statistical significance in the complete-case models, indicating sensitivity to missing-data handling. Albumin associations varied by outcome and analysis.
Conclusion: The primary findings concern associations of continuous T-cell and NK-cell counts with inflammatory and nutritional markers, with NLR showing consistent associations across analyses. Cohort-defined low-count status was a secondary, exploratory outcome. These findings do not establish causality or validated clinical thresholds and require prospective validation with standardized sampling and perioperative data.
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BibTeX
@article{duan2026lower,
title = {{Lower peripheral T- and NK-cell counts are associated with systemic inflammation and nutritional status in hospitalized gastrointestinal surgery patients}},
author = {Zhi Duan and Xiangjuan Jiao and Ning Wang and Wubin Zhou and Jiao He and Lingyong Liu and Qi Zuo and Zhen Li},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1916752},
url = {https://doi.org/10.3389/fmed.2026.1916752},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lower peripheral T- and NK-cell counts are associated with systemic inflammation and nutritional status in hospitalized gastrointestinal surgery patients
AU - Zhi Duan
AU - Xiangjuan Jiao
AU - Ning Wang
AU - Wubin Zhou
AU - Jiao He
AU - Lingyong Liu
AU - Qi Zuo
AU - Zhen Li
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1916752
UR - https://doi.org/10.3389/fmed.2026.1916752
AB - Background: Systemic inflammation and impaired nutritional status may be associated with altered cellular immune profiles in surgical inpatients. However, peripheral T- and NK-cell profiles and their clinical correlates remain insufficiently characterized in hospitalized gastrointestinal surgery patients. Methods: This retrospective observational study included hospitalized patients from a gastrointestinal surgery department who underwent peripheral blood lymphocyte subset testing between January 2024 and May 2025. Patients were classified into disease categories according to discharge diagnoses. T lymphocytes, natural killer (NK) cells, B lymphocytes, and NKT cells were analyzed together with inflammatory markers, including interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and nutritional markers including serum albumin and hemoglobin. Group comparisons, correlation analyses, and multivariable regression were performed. Continuous T-cell and NK-cell counts were the primary outcomes; cohort-defined low-count status was a secondary exploratory outcome. Sensitivity analyses included multiple imputation and Firth penalized logistic regression. Results: After excluding one patient with missing diagnosis, 887 patients were included, of whom 623 had complete data for multivariable analysis. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with lower continuous T-cell and NK-cell counts and higher odds of low-count status across complete-case and sensitivity analyses. In models pooled across 50 imputed datasets, obstruction/perforation-related acute abdomen, compared with benign anorectal diseases, was associated with lower T-cell counts (adjusted geometric mean ratio [aGMR] = 0.822, 95% CI 0.706–0.958, P = 0.012) and lower NK-cell counts (aGMR = 0.821, 95% CI 0.677–0.995, P = 0.045). These associations did not reach statistical significance in the complete-case models, indicating sensitivity to missing-data handling. Albumin associations varied by outcome and analysis. Conclusion: The primary findings concern associations of continuous T-cell and NK-cell counts with inflammatory and nutritional markers, with NLR showing consistent associations across analyses. Cohort-defined low-count status was a secondary, exploratory outcome. These findings do not establish causality or validated clinical thresholds and require prospective validation with standardized sampling and perioperative data.
SN - 2296-858X
ER -