High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2022 Sep 22

PMID 36131811

Authors

Ketut Suryana

Ni Wayan Wina Dharmesti

I B Ngurah Rai

Affiliations

Soon will be listed here.

Abstract

Introduction: Patients with delayed intensive phase sputum conversion have a higher risk of multidrug resistant-tuberculosis (MDR-TB) and poorer treatment outcomes. Both, host (immune response and comorbidity) and pathogen factors play important roles in determining sputum conversion after treatment initiation. Impaired host immune response, especially the cellular components, as defined by the increased pre-treatment level of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and other additional factors, were associated with severe active TB.

Purpose: To evaluate whether impaired immune responses (high pre-treatment level of NLR and MLR) and other factors associate with delayed sputum conversion at the end of the intensive phase treatment.

Patients And Methods: This was a case-control study from 2016 to 2020, which retrospectively analyzed the pre-treatment level of NLR, MLR and other factors among patients with new cases of pulmonary tuberculosis (PTB).

Results: A total of 62 patients (31 cases and 31 control). The cut-off value of high pretreatment level of NLR and MLR was 5.065 and 0.585, respectively. Bivariate analysis showed that pretreatment NLR ≥5.065 (OR 8.23, CI 95% 2.48-27.32, < 0.001), MLR ≥0.585 (OR 10.18, 95% CI 3.13-33.18, < 0.001) and BMI <18.5 (OR 2.91, 95% CI 1.03-8.20, p = 0.041) were associated with an increased risk of delayed sputum conversion. Multivariate analysis, however, showed that pretreatment NLR ≥5.065 was not significantly associated with delayed sputum conversion (AOR 3.370, 95% CI 0.71-15.91, value 0.125). A high pretreatment of MLR (AOR 30.802, 95% CI 3.22-287.55, value 0.003) and lower BMI (AOR 10.942, 95% CI 1.121-98.563, value 0.033) were significantly associated with an increased risk of delayed intensive phase sputum conversion.

Conclusion: High MLR pretreatment and a low BMI were significantly associated with an increased risk of delayed sputum conversion at the end of the PTB intensive phase treatment. High NLR pretreatment, smoking, diabetes, and HIV were not associated with sputum conversion.

Citing Articles

Association Between Indices of Peripheral Blood Inflammation and Cavitary Pulmonary Tuberculosis.

He X, Hou H, Jiang Y, Huang X Int J Gen Med. 2024; 17:5133-5142.

PMID: 39529941 PMC: 11552384. DOI: 10.2147/IJGM.S483185.

Construction and Validation of a Nomogram to Identify the Risk of Cavitation in Pulmonary Tuberculosis.

Song M, Zhang M, Han J, Fu W Infect Drug Resist. 2024; 17:2803-2813.

PMID: 38989008 PMC: 11233379. DOI: 10.2147/IDR.S459330.

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

Omair M, Baig M, Farooqui W, Kousar S, Noori M, Zeehan N BMC Infect Dis. 2024; 24(1):615.

PMID: 38907220 PMC: 11191182. DOI: 10.1186/s12879-024-09454-2.

A longitudinal prospective study of active tuberculosis in a Western Europe setting: insights and findings.

Romero-Tamarit A, Valles X, Munar-Garcia M, Espinosa-Pereiro J, Saborit N, Tortola M Infection. 2024; 52(2):611-623.

PMID: 38349459 PMC: 10954962. DOI: 10.1007/s15010-024-02184-2.

Diagnostic value of the neutrophil lymphocyte ratio in discrimination between tuberculosis and bacterial community acquired pneumonia: A -analysis.

Shojaan H, Kalami N, Ghasempour Alamdari M, Emami Alorizy S, Ghaedi A, Bazrgar A J Clin Tuberc Other Mycobact Dis. 2023; 33:100395.

PMID: 37692090 PMC: 10485633. DOI: 10.1016/j.jctube.2023.100395.

References

Su W, Feng J, Chiu Y, Huang S, Lee Y . Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis. Eur Respir J. 2010; 37(2):376-83. DOI: 10.1183/09031936.00007410. View

La Manna M, Orlando V, Dieli F, Di Carlo P, Cascio A, Cuzzi G . Quantitative and qualitative profiles of circulating monocytes may help identifying tuberculosis infection and disease stages. PLoS One. 2017; 12(2):e0171358. PMC: 5313257. DOI: 10.1371/journal.pone.0171358. View

Stefanescu S, Cocos R, Turcu-Stiolica A, Mahler B, Meca A, Giura A . Evaluation of prognostic significance of hematological profiles after the intensive phase treatment in pulmonary tuberculosis patients from Romania. PLoS One. 2021; 16(4):e0249301. PMC: 8016233. DOI: 10.1371/journal.pone.0249301. View

Gunda D, Nkandala I, Kavishe G, Kilonzo S, Kabangila R, Mpondo B . Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study. J Trop Med. 2017; 2017:5352906. PMC: 5485336. DOI: 10.1155/2017/5352906. View

Merriman R, Dissanayake O, Alnjar S, Burns F, Miller R . Incidence and significance of elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios among hospitalised HIV-positive adult patients. Int J STD AIDS. 2019; 30(13):1329-1332. DOI: 10.1177/0956462419868881. View

Caetano Mota P, Carvalho A, Valente I, Braga R, Duarte R . Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis. Rev Port Pneumol. 2012; 18(2):72-9. DOI: 10.1016/j.rppneu.2011.12.005. View

Kubiak R, Sarkar S, Horsburgh C, Roy G, Kratz M, Reshma A . Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis. 2019; 19(1):627. PMC: 6636094. DOI: 10.1186/s12879-019-4244-4. View

Rees C, Pineros D, Amour M, Munseri P, Said J, Magohe A . The potential of CBC-derived ratios (monocyte-to-lymphocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte) to predict or diagnose incident TB infection in Tanzanian adolescents. BMC Infect Dis. 2020; 20(1):609. PMC: 7433160. DOI: 10.1186/s12879-020-05331-w. View

Wang J, Yin Y, Wang X, Pei H, Kuai S, Gu L . Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Braz J Infect Dis. 2014; 19(2):125-31. PMC: 9425257. DOI: 10.1016/j.bjid.2014.10.008. View

10.

Cailleaux-Cezar M, Loredo C, Lapa E Silva J, Conde M . Impact of smoking on sputum culture conversion and pulmonary tuberculosis treatment outcomes in Brazil: a retrospective cohort study. J Bras Pneumol. 2018; 44(2):99-105. PMC: 6044654. DOI: 10.1590/s1806-37562017000000161. View

11.

Chiang C, Bai K, Lin H, Chien S, Lee J, Enarson D . The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis. PLoS One. 2015; 10(3):e0121698. PMC: 4378948. DOI: 10.1371/journal.pone.0121698. View

12.

Shah N, Wright A, Bai G, Barrera L, Boulahbal F, Martin-Casabona N . Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis. 2007; 13(3):380-7. PMC: 2725916. DOI: 10.3201/eid1303.061400. View

13.

Moreira-Teixeira L, Mayer-Barber K, Sher A, OGarra A . Type I interferons in tuberculosis: Foe and occasionally friend. J Exp Med. 2018; 215(5):1273-1285. PMC: 5940272. DOI: 10.1084/jem.20180325. View

14.

Wang W, Wang L, Liu Y, Yang F, Zhu L, Zhang X . Value of the Ratio of Monocytes to Lymphocytes for Monitoring Tuberculosis Therapy. Can J Infect Dis Med Microbiol. 2019; 2019:3270393. PMC: 6556807. DOI: 10.1155/2019/3270393. View

15.

Tobin D, Roca F, Oh S, McFarland R, Vickery T, Ray J . Host genotype-specific therapies can optimize the inflammatory response to mycobacterial infections. Cell. 2012; 148(3):434-46. PMC: 3433720. DOI: 10.1016/j.cell.2011.12.023. View

16.

Calderwood C, Wilson J, Fielding K, Harris R, Karat A, Mansukhani R . Dynamics of sputum conversion during effective tuberculosis treatment: A systematic review and meta-analysis. PLoS Med. 2021; 18(4):e1003566. PMC: 8109831. DOI: 10.1371/journal.pmed.1003566. View

17.

Kayigamba F, Bakker M, Mugisha V, De Naeyer L, Gasana M, Cobelens F . Adherence to tuberculosis treatment, sputum smear conversion and mortality: a retrospective cohort study in 48 Rwandan clinics. PLoS One. 2013; 8(9):e73501. PMC: 3774710. DOI: 10.1371/journal.pone.0073501. View

18.

Chandrasekaran P, Saravanan N, Bethunaickan R, Tripathy S . Malnutrition: Modulator of Immune Responses in Tuberculosis. Front Immunol. 2017; 8:1316. PMC: 5651251. DOI: 10.3389/fimmu.2017.01316. View

19.

Lastrucci C, Benard A, Balboa L, Pingris K, Souriant S, Poincloux R . Tuberculosis is associated with expansion of a motile, permissive and immunomodulatory CD16(+) monocyte population via the IL-10/STAT3 axis. Cell Res. 2015; 25(12):1333-51. PMC: 4670988. DOI: 10.1038/cr.2015.123. View

20.

Yin Y, Kuai S, Liu J, Zhang Y, Shan Z, Gu L . Pretreatment neutrophil-to-lymphocyte ratio in peripheral blood was associated with pulmonary tuberculosis retreatment. Arch Med Sci. 2017; 13(2):404-411. PMC: 5332451. DOI: 10.5114/aoms.2016.60822. View