Evaluation of the diagnostic utility of leucocyte in comparison to other biomarkers in the management of patients with pulmonary tuberculosis

Abstract

Background: Pulmonary tuberculosis (PTB) is an infectious and debilitating disease that affects millions of people each year. Simple, reliable and cost effective biomarkers are vital to fore-stall the morbidity and mortality that is hallmark of the infection especially in resource poor economy.Methods: This comparative study enlisted 140 subjects: 80 had PTB and 60 do not. Blood of 8mls was collected; 3mls in K2-EDTA for FBC testing with XE-2100 Sysmex and ESR by Westergreen method. The remainder was used for serum CRP assay by ELISA. The radiological extent was determined from Chest X ray report and disease severity using modified Bandim TB scoring was extracted from the case note. The aim of the study is to investigate the relationship and diagnostic utility between leucocyte with CRP, ESR, radiological extent of disease and disease severity in PTB.Results: Mean Lymphocyte count was lower while TWBC, Neutrophil and Monocyte counts were higher in subjects compared to control (p<0.05). Median CRP, ESR, NLR, NMR and MLR were higher in subjects compared to control (p<0.05), NLR and MLR showed strong positive significant correlation with ESR, disease severity, and radiological extend of disease. NMR (p= 0.00) had a negative correlation with ESR (p<0.05) and inverse correlation with disease severity and radiological extent.Conclusions: This study found NLR, MLR and NMR as a readily, easily available and inexpensive indices that are as efficient and comparable to known biomarkers in PTB infection, therefore could serve as valuable predictive biomarker in areas of high disease burden with weak economy.

Accuracy of monocyte to lymphocyte ratio for tuberculosis diagnosis and its role in monitoring anti-tuberculosis treatment: Systematic review and meta-analysis

“…This in turn causes delays in diagnosis that exacerbate the patient's morbidity and mortality. [34] We also aimed to investigate the role of MLR in monitoring anti-TB therapy. Accordingly, the pooled results from 6 studies showed that there is a significant reduction in the MLR value after anti-TB treatment in TB patients (SMD = 0.68; 95% CI: 0.007, which then settles under the effect of anti-tuberculosis therapy.…”

Relationship of neutrophil lymphocyte ratio, monocyte lymphocyte ratio and neutrophil monocyte ratio with treatment response in pulmonary tuberculosis patients during intensive phase treatment

“…Notably, 10.52% of non-responders showed INH resistance with no ratio improvement, indicating that the test could be useful in detecting mycobacterial resistance by the second month of treatment. MLR has been identified as a possible predictor of bloodstream infections and drug resistance [ 11 ]. Naranbhai et al suggests that NLR and MLR play a predictive role in detecting early disease severity and mortality [ 18 , 28 , 29 ].…”

“…This implies that MLR and NLR should be high while the disease is active and normal or low when the patient has a healthy immune system. They could thus be used as a TB forecasting tool [ 11 , 21 , 23 , 24 ].…”

“…Several researchers have discovered the possible relevance of different leukocyte ratios in following inflammatory processes e.g. cardiovascular and chronic renal disease, diabetes, hypertension, and TB [ 1 , 8 – 11 ]. The total leukocyte count (TLC) often increases in response to various factors including inflammation, infection, trauma, and hormonal influences [ 12 , 13 ].…”

“…Studies have shown the utility of leukocyte ratios, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-monocyte ratio (NMR), in various bacterial infections, including TB [ 17 ]. These ratios have been used as a marker to see treatment response and severity of various diseases [ 11 , 18 , 19 ]. However very limited studies, which have shown that hematological parameters play an essential role in treatment strategies.…”