Neutrophil-to-Monocyte-Plus-Lymphocyte Ratio as a Potential Marker for Discriminating Pulmonary Tuberculosis From Nontuberculosis Infectious Lung Diseases

You La Jeon, MD, PhD; Woo-In Lee, MD, PhD; So Young Kang, MD, PhD; Myeong Hee Kim, MD, PhD


Lab Med. 2019;50(3):286-291. 

In This Article

Material and Methods

We conducted a retrospective analysis of the demographic characteristics, clinical information, and laboratory test results of 110 patients with pulmonary TB and 159 patients diagnosed with non-TB infectious lung diseases between January 2016 and December 2017. All subjects underwent 3 or more Mycobacterium tuberculosis (MTB) culture tests and/or molecular study (TB–polymerase chain reaction [PCR] or X-pert MTB [Cepheid Inc.]) to confirm TB infection. TB was diagnosed in patients with positive culture study results or adenosine deaminase level of 70 IU per dL or greater with lymphocyte-dominant exudative pleural effusion and lung parenchymal lesion implying pulmonary TB.

Patients with clinical symptoms related to TB or radiologic findings of suspected TB showing effective response to anti-TB drug were included in the study, even if their results from MTB culture were negative. Patients with non-TB mycobacterial infection were excluded. The characteristics of the patients with TB, according to diagnostic criteria, are introduced in Table 1. Patients with non-TB infectious lung diseases (non-TB group) included those with bacterial or viral pneumonia, aspiration pneumonia, or empyema.

The collected data included CBC results and levels of C-reactive protein (CRP) as a common infectious disease marker. These values were measured on patient admission. The value of the original CBC parameters and modified CBC indices were compared between patients with TB and those without TB.

Also, we analyzed the distributions of the NMLR value in 220 healthy subjects as a control group. These subjects were randomly selected from among individuals who underwent health check-ups at the same time as the patient-recruitment period. The demographic characteristics of the healthy subjects were as follows: mean (SD), 50.12 (10.87) years and sex ratio (male:female), 132:88. This study was approved by Institutional Review Board of Kyung Hee University Hospital at Gangdong, Seoul, South Korea.

For statistical analysis, we usd SPSS Statistics software for Windows, version 20.0 (IBM Corporation) and Medcalc software (Medcalc Software bvba). The data were presented as numbers or mean (SD). Continuous variables were analyzed using Mann-Whitney U tests for 2 groups. We used Pearson χ 2 testing for categorical variables. The comparisons of receiver operating characteristic (ROC) curves between variable parameters were performed using MedCalc software for Windows, version 11.0. P values of .05 or less were considered statistically significant.