Reversal of Neutrophil-to-Lymphocyte Ratio Due to Nutritional Therapy in Lung Abscess Suspected Tuberculosis Patient with Severe Protein-Energy Malnutrition

Abstract

Objectives Severe malnutrition is associated with poor outcomes and higher mortality in Tuberculosis (TB) patients. Due to the inflammatory process, TB patients are in hypercatabolic conditions which caused increased nutritional requirements. Neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status that can be used to determine the outcome of TB patients. Methods A 53-year-old male patient with severe protein-energy malnutrition (body mass index 14.5 kg/m2) suffers from a lung abscess due to tuberculosis (TB) suspected being treated at the infection center of Wahidin Sudirohusodo Hospital, Makassar. Oral intake decreased due to shortness of breath and loss of appetite. Physical examination showed conjunctival anemia, loss of subcutaneous fat, lung rales, and muscle wasting. Laboratory assessments showed hypoalbuminemia (1.8 g/dl), hyponatremia (126 mmol/L), leukocytosis (26,100/ɥl), neutrophilia (19,600/ɥl, Neutrophil-to-Lymphocyte/NLR ratio 4.2), anemia (9,6 g/dl), and elevated liver enzymes (SGOT 90 U/L and SGPT 114 U/L). Results Nutrition therapy was given gradually with a target calorie of 1700–2300 kcal and protein 1.5–2 g/ideal body weight/day using regular food, high protein formula, and amino acids (parenteral nutrition). After 12 days of nutrition treatment, the patient was discharged from the hospital without shortness of breath, adequate nutritional intake, improved anthropometric parameters, and laboratory test results (leukocytes 9000/ɥl, neutrophil 4698/ɥl, NLR 1.6, albumin 3.0 g/dl, Hb 10.5 g/dl, and sodium 135 mmol/L). Conclusions Nutritional therapy is essential in TB patient’s hypercatabolic states. By achieving nutritional requirements, there can be changes in the value of Neutrophil-to-Lymphocyte Ratio so that it alters the course and the outcome of TB disease. Severe malnutrition is associated with poor outcomes and higher mortality in Tuberculosis (TB) patients. TB patients are in hypercatabolic conditions due to the inflammatory process so that they have increased nutritional requirements. Neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status that can be used to determine the outcome of TB patients. Funding Sources The author(s) received no financial support for the research, authorship, and/or publication of this article.