Higher Neutrophil-lymphocyte Ratio in TB/HIV Co-infection Compared to Pulmonary Tuberculosis

Abstract

BACKGROUND: Neutrophils and lymphocytes play a significant role in inflammation and a highratio of neutrophils over lymphocytes (NLR) hasbeen used as an inflammatory marker to predict the severityof various diseases. Here we compared the NLR amongpulmonary tuberculosis and TB/HIV co-infection.METHODS: A retrospective cross-sectional study wasconducted, included patients with pulmonary TB withoutcavitation TB (n=50), with cavitation TB (n=50) and HIVco-infection (n=27). Complete blood count was examined,including neutrophils and lymphocyte. NLR was calculatedand compared between groups.RESULTS: Neutrophils were significantly higher(p=0.004) in TB with cavitation compared to those withno cavitation (8.27±1.45 x103/μL vs. 6.61±1.4 x103/μL,respectively); whereas the lymphocytes were similar in both groups, resulting in a significantly higher NLR(p=0.009) in pulmonary TB with cavitation compared topulmonary TB with no cavitation (5.98±1.85 vs. 4.42±1.86,respectively). On the contrary, both neutrophils as well aslymphocyte were significantly lower in TB/HIV comparedto pulmonary TB, which for neutrophil were 5.14±2.19x103/μL vs. 7.4±1.45 x103/μL, respectively (p=0.003) andfor lymphocyte (1.02 ±0.57 x103/μL vs. 1.57±0.64 x103/μL,respectively (p=0.001), resulting in a significantly higher(p=0.041) NLR value in TB/HIV (6.05±2.67) compared topulmonary TB (5.16±1.88).CONCLUSION: High NLR in pulmonary TB withcavitation as well as in TB with HIV co-infection may beof great interest for biomarker in TB severity. Further studyconfirming NLR as potential marker is imperative