Diagnostic value of neutrophil-to-lymphocyte ratio, fibrinogen-to-albumin ratio and red blood cell distribution width in tuberculosis combined with bacterial infection

doi:10.21203/rs.3.rs-5014708/v1

Objective: To investigate the clinical significance of neutrophil-to-lymphocyte ratio (NLR), fibrinogen-to-albumin ratio (FAR), and red blood cell distribution width (RDW) in pulmonary tuberculosis (PTB) combined with bacterial infection of the lung.

Metheds: 74 patients with pulmonary tuberculosis combined with bacterial infection of the lung attending the Sixth People's Hospital of Nantong City from January 2021 to December 2024 were selected as the infected group, and 96 patients with simple pulmonary tuberculosis admitted during the same period were selected as non-infected group, and the levels of NLR, FAR, and RDW in peripheral blood of the patients of the two groups were collected for determination, and NLR, FAR and RDW levels of the patients of the two groups were compared.The receiver operating characteristic (ROC) curve was used to assess the performance of the above indicators for early diagnosis of PTB combined with bacterial infection.

Results: The levels of NLR, FAR and RDW were significantly higher in the infected group compared with the non-infected group, and the differences were statistically significant (P < 0.05).The levels of NLR were positively correlated with the levels of leukocytes, C-reactive protein and D-dimer.ROC curve analysis showed that the area under the curve (AUC) for the diagnosis of pulmonary tuberculosis combined with bacterial infection by blood NLR, FAR and RDW were 0.861, 0.818, 0.799; the AUC value after the combination of the three was 0.982. The validation results showed that the diagnostic sensitivity (98.6%) and specificity (89.58%) of NLR and FAR combined with RDW were higher than those of NLR, FAR and RDW alone.

Conclusion: Combined detection of blood NLR, FAR and RDW levels has high clinical diagnostic value for diagnosing pulmonary tuberculosis combined with bacterial infection.

tuberculosis

bacterial infection

neutrophils

lymphocytes

fibrinogen

albumin

red blood cell distribution width

Pulmonary tuberculosis(PTB) is a common infectious disease of the lungs caused by respiratory[1].About 10 million people develop tuberculosis and 1.5 million die from it each year[2].The major burden of PTB is borne by the elderly, men and clinically diagnosed patients, especially in China[3].Clinical practice has found that there are more patients with pulmonary bacterial infections on the basis of pulmonary tuberculosis, and it is difficult to identify them by conventional diagnostic methods, especially for patients with bacterial-negative pulmonary tuberculosis, which is difficult to diagnose due to the atypical imaging examination and obvious fever manifestations accompanied by abnormalities in laboratory indexes such as the erythrocyte sedimentation rate, C-reactive protein and leukocyte counts. At present, the diagnosis is mainly made through anti-infective treatment or parallel treatment of anti-tuberculosis and anti-infective treatment, and then based on the absorption of the lesion on chest X-ray and CT examination, which may lead to irrational application of drugs and delay of the patient's condition[4, 5].Therefore, there is an urgent need to develop a rapid and accurate diagnostic test for tuberculosis.Neutrophil-to-lymphocyte ratio (NLR), fibrinogen-to-albumin ratio (FAR)and red blood cell distribution width (RDW) have been used as new pathogenic markers to assess the severity of inflammation[6–8].Because these rates can be easily and quickly obtained, an increasing number of studies have focused on these indicators.Significant changes in NLR, FAR and RDW are well assessed in several common acute and chronic diseases, including neoplasms [9–11],cardiovascular diseases [12, 13], allergic diseases [14,15].They have attracted attention as potential diagnostic indicators that can aid risk assessment and clinical decision-making.There are fewer studies related to the systematic study of the value of NLR, FAR and RDW in the differential diagnosis of tuberculosis combined with bacterial infection.Therefore, the aim of this study was to investigate the diagnostic value of NLR, FAR and RDW in patients with tuberculosis combined with bacterial infection, and to provide a more accurate and reliable basis for the differential diagnosis and individualised treatment of patients with clinical tuberculosis combined with bacterial infection.

Case selection

In this study, 74 patients with tuberculosis combined with bacterial infection admitted to the Sixth People's Hospital of Nantong City during the period from January 2021 to December 2023 were selected as the infected group, according to Acute Physiology and Chronic Health Evaluation (APACHE) II score,categorised into 21 cases of severe group and 53 cases of non-severe group.as well as 96 patients with simple tuberculosis during the same period as the non-infected group.And 170 patients were selected who met the diagnostic criteria for tuberculosis. Bacterial infections of the lungs with reference to Infectious Diseases Society of America/American Thoracic Society criteria[16].The study protocol was approved by the Ethics Committee of the Sixth People's Hospital of Nantong ( NTLYLL2024009). Patients gave informed consent and signed an informed consent form.

Laboratory measurements

Collect 5 ml of fasting elbow vein blood from patients of both groups in the early morning, put it in the procoagulation tube, centrifuge it at 3 000 r/min for 10 min, take the supernatant and store it in the refrigerator at -80 ℃ to be measured, and then use the Beckman AU5800 biochemical analyser(Tokyo, Japan) to detect the albumin level. Neutrophils, lymphocytes and red blood cell distribution width were detected by using Myeri BC6900 blood cell analyser(Shenzhen Mindray Bio-Medical Electronics Co. Ltd.China). Fibrinogen was detected using HysonMedicom CS5100 coagulation analyser(Tokyo, Japan). NLR and FAR were calculated based on the test results.

Data analysis

SPSS17.0 software was used for data processing. Normally distributed measurements were expressed as mean ± standard deviation, comparisons between two groups were made using the paired t-test, and correlations between data were analysed using Pearson correlation analysis. Comparison of categorical information was performed using chi-square test. Comparison of rates was performed using Fisher's exact probability method. Logistic regression equations were used to calculate the probability of the joint diagnosis of NLR, FAR, and RDW, and the Receiver Operating Characteristic (ROC) curve of the subjects was plotted, and the area under the curve (AUC) was calculated to assess the efficacy of NLR, FAR and RDW in diagnosing pulmonary tuberculosis combined with bacterial infection.P value < 0.05 was considered statistically significant.

Comparison of general clinical data between the two groups

There was no statistically significant difference between the infected group and the non-infected group in terms of age 、 sex ratio、hypertension、diabetes mellitus and smoking history (t/x² values of 0.019, 1.935, 3.534, 0.554, and 0.003, respectively, P > 0.05)(Table 1).

Table 1

Comparison of clinical characteristics between the infected group and non-infected group
Data	Group
Data	Non-infected group (number = 96)	Infected group (number = 74)	t/x²	P
Age(year)	62.52 ± 7.638	67.51 ± 8.10	0.019	0.891
Gender
Male	69(71.9)	60(81.1)	1.935	0.206
Female	27(28.1)	14(18.9)	1.935	0.206
Pulse(times/min)	80.18 ± 12.77	82.04 ± 13.70	0.914	0.367
Breathing(times/min)	17.90 ± 2.38	18.62 ± 2.83	1.772	0.078
Systolic pressure(mmHg)	126.27 ± 15.09	127.15 ± 24.31	0.273	0.785
Diastolic pressure(mmHg)	78.01 ± 9.98	76.05 ± 15.69	-0.936	0.351
Hypertension
Yes	19(19.8)	24(32.4)	3.534	0.075
No	77(80.2)	50(67.6)	3.534	0.075
Diabetes
Yes	20(20.8)	19(25.7)	0.554	0.468
No	76(79.2)	55(74.3)	0.554	0.468
Somking
Yes	23(24.0)	18(24.3)	0.003	0.958
No	73(76.0)	56(75.7)	0.003	0.958
Drink
Yes	15(15.6)	12(16.2)	0.011	0.917
No	81(84.4)	62(83.8)	0.011	0.917
Hemoptysis
Yes	26(27.0)	16(21.6)	0.676	0.414
No	70(73.0)	58(78.3)	0.676	0.414
Fever
Yes	14(14.6)	14(18.9)	0.567	0.451
No	82(85.4)	60(81.1)	0.567	0.451

Correlation analysis of blood NLR, FAR, RDW levels and various clinical indicators

RDW levels were positively correlated with c-reactive protein、d-dimer、erythrocyte sedimentation rate and ferritin levels in 170 patients in the infected and non-infected groups (P < 0.05).NLR levels were positively correlated with leukocyte, c-reactive protein and d-dimer levels (P < 0.05).FAR levels were positively correlated with leukocyte、 platelet、c-reactive protein、d-dimer、 erythrocyte sedimentation rate and ferritin levels (P < 0.05). NLR was highly positively correlated with leukocyte levels (r = 0.614, P < 0.01), and procalcitonin levels were not correlated with RDW, NLR and FAR levels (P > 0.05). (Table 2)

Table 2

Correlations of NLR、FAR and RDW with clinical characteristics of the patients
Index	RDW		NLR		FAR
Index	r	p	r	p	r	p
Leucocyte	0.149	0.138	0.614	< 0.001	0.381	< 0.001
Hemoglobin	-4.99	< 0.001	-0.257	0.009	-0.291	0.03
Platelet	-0.003	0.976	0.205	0.039	0.437	< 0.001
C-reactive protein	0.355	< 0.001	0.555	< 0.001	0.584	< 0.001
D-Dimer	0.262	0.008	0.318	0.001	0.299	0.002
Erythrocyte sedimentation rate	0.318	0.001	0.163	0.104	0.676	< 0.001
Procalcitonin	0.164	0.101	0.122	0.223	0.135	0.178
Ferritin	0.200	0.045	0.132	0.101	0.398	< 0.001

Comparison of NLR, FAR and RDW levels between the two groups

Detecting the levels of NLR, FAR and RDW in the infected group and the non-infected group,the levels were 6.204 (4.328,9.348), 0.145 (0.120,0.192), 14.400 (13.200,15.625) in the infected group, 2.726 (2.159,3.821), 0.095 ( 0.071.0.126) and 12.800 (12.200,13.400)in the non-infected group, and the differences were statistically significant ( P < 0.001,Table 3)

Table 3

Comparison of laboratory indicators between the infected group and non-infected group
Group	n	RDW(%)	NLR	FAR
Infected group	74	14.400(13.200,15.625)	6.204(4.328,9.348)	0.145(0.120,0.192)
Non-infected group	96	12.800(12.200,13.400)	2.726(2.159,3.821)	0.095(0.071.0.126)
Z		-6.709	-8.059	-7.091
P		< 0.001	< 0.001	< 0.001

Table 3

Comparison of NLR,FAR,RDW levels between severe group and non-severe group
Index	Severe group(number = 21)	Non-severe group(number = 53)	Z	P
RDW(%)	15.600(14.500,16.900)	14.100(12.900,15.100)	-3.455	< 0.001
NLR	9.878(7.171,13.918)	5.081(3.829,8.203)	-3.999	< 0.001
FAR	0.186(0.144.0.268)	0.138(0.113,0.167)	-3.903	< 0.001

Serum NLR, FAR, RDW levels in severe group and non-severe group

The levels of NLR, FAR and RDW in the severe group were higher than those in the non-severe group(P < 0.05,Table 3).

Clinical value of NLR, FAR and RDW levels in the diagnosis of tuberculosis combined with bacterial infection

The results of ROC curve showed that the AUC value of NLR was 0.861, Youden index was 0.617, sensitivity: 0.784, specificity: 0.833; the AUC value of FAR was 0.818, Youden index was 0.559, sensitivity: 0.892, specificity: 0.667; the AUC value of RDW was 0.799, the Youden's index was 0.563, sensitivity: 0.865, specificity: 0.698, and the AUC value of the combination of NLR, FAR and RDW was 0.982, Youden's index was 0.882, sensitivity: 0.986, specificity: 0.896. (Table 4, Fig. 1)

Table 4

ROC curve of diagnostic efficacy of NLR, FAR and RDW in patients with tuberculosis combined with bacterial infection
Index	Cut-off Value	Sensitivity/%	Specificity/%	Youden index/%	AUC	Plr(%)	Nlr(%)	95% confidence interval
RDW	12.850	86.50	69.79	56.29	0.799	2.86	19.34	0.730–0.869
NLR	4.261	78.40	83.33	61.73	0.861	4.70	25.92	0.803–0.919
FAR	0.107	89.20	66.66	55.86	0.818	2.67	16.20	0.755–0.881
Joint diagnosis		98.60	89.58	88.18	0.982	9.46	1.56	0.968–0.996

Tuberculosis is an infectious disease caused by mycobacterium tuberculosis[1, 17].Significant increase in susceptibility to PTB and risk of death among people aged 65 and over[18].Elderly patients with PTB have a low sputum smear positivity rate, making diagnosis difficult and prone to delayed diagnosis. In addition, due to decreased immunity and more comorbidities, the elderly are more prone to treatment-related adverse drug reactions, poor therapeutic outcomes and high mortality rates[19].Co-infections with tuberculosis and bacterial pathogens have been reported, especially in populations with a high prevalence of tuberculosis.[20].Distinguishing tuberculosis from tuberculosis co-infection with bacterial infections is an important clinical challenge[21], and the inability to distinguish tuberculosis from tuberculosis co-infection with bacterial infections may lead to poorer health outcomes, including increased healthcare costs, antimicrobial drug resistance and mortality[22, 23].Bacterial culture is the gold standard for determining bacterial infection.However, the examination of bacterial cultures has a weakness; the cost of examination of bacterial cultures is quite expensive and the test takes a long time. The fastest culture results are known to exceed 24 hours [24].Therefore, combined lung infections in elderly patients with tuberculosis often lead to misdiagnosis and underdiagnosis due to the lack of effective diagnostic and therapeutic means, and the search for biomarkers for the early and rapid diagnosis of bacterial infections is a key issue that needs to be focused on by clinicians at present. The search for biomarkers for early and rapid diagnosis of bacterial infections is a key issue for clinicians to focus on.

NLR is a ratio that is more accurate than White blood cell count. Neutrophils and lymphocytes reflect not only the role of neutrophils in infection, but also the changes in lymphocytes in the body, in time to recognise the type of pathogen.The NLR is a low-cost, routinely used, reproducible assay that can be derived from a white blood cell count and has been shown to be a marker of the systemic inflammatory response[10, 25].In this study, the level of NLR in the infected group was significantly higher than that in the non-infected group (P < 0.05), and the level of NLR in the infected group was higher in the critically ill patients than in the non-critically ill patients, which is also in agreement with the findings of Nagai [26]et al.During infection, dendritic cells can present antigens to natural killer T cells, leading to local extravasation of neutrophils, which promotes the entry of natural killer T cells into tissues and affects peripheral blood lymphocytes. Therefore, NLR can better dynamically respond to the infection status of the organism[26, 27].

RDW is a parameter that reflects the heterogeneity of red blood cell volume. Previous studies have suggested that RDW may be a laboratory indicator of infection or inflammation[28].Hu et al. demonstrated high expression of RDW levels in elderly patients with lung infections undergoing general anesthesia for abdominal surgery with tracheal intubation, and that RDW was involved in the development of lung infections and aggravation of patients' conditions[29].In addition, one study reported that elevated RDW values were associated with the severity of neonatal sepsis[30].The levels of RDW were significantly higher in the infected group than in the non-infected group in this study (P < 0.05), which was also consistent with the severity of the disease. RDW levels were positively correlated with c-reactive protein、d-dimer、erythrocyte sedimentation rate and ferritin levels (all P < 0.05).

This is the first retrospective study of FAR in tuberculosis disease.Fibrinogen is an acute-phase protein synthesized by the liver that increases rapidly in acute-phase illnesses, such as bacterial infections and trauma[31].Albumin are negative counter-reactors that enhance catabolism to fight inflammation[32].FAR is a combination of fibrinogen and albumin levels that can be used as a potential prognostic biomarker for predicting risk of various diseases.Zhao et al. reported the relationship between FAR and diabetic cardiac autonomic neuropathy (DCAN) in patients with type 2 diabetes mellitus(T2DM). For the first time, FAR was found to be an independent predictor of the risk of developing DCAN in T2DM[33].Wang et al. demonstrated that high levels of fibrinogen to albumin ratios on admission may be closely related to hematoma expansion after cerebral hemorrhage[34].Other studies have reported tha higher FAR levels are associated with a higher increased risk of in-hospital mortality in critically ill patients with acute kidney injury[35].In this study, we found that FAR levels were significantly higher in the infected group compared to the non-infected group, and there was a positive correlation between FAR levels and the levels of leukocytes、platelets、c-reactive protein、d-dimer、erythrocyte sedimentation rate and ferritin (all P < 0.05) and that increased FAR levels correlated with the severity of tuberculosis and had a predictive value.ROC curve analysis showed that the AUC of NLR, FAR and RDW were 0.861, 0.818 and 0.799.Our attempt to combine NLR, RDW and FAR dramatically improved our ability to predict PTB combined with bacterial infection with an AUC value of 0.982, a sensitivity of 0.986% and a specificity of 89.6%. All of them were higher than individual indicators.The above results suggest that peripheral blood NLR, FAR and RDW levels may provide a better early diagnosis of PTB combined with bacterial infection.The present study is a retrospective study based on prospective data with many limitations such as small sample size from a single centre and inclusion of only patients with PTB and PTB with bacterial infections, which needs to be validated by further expansion of the specimen size.And the experimental subjects selected for this study were not stratified for pathogenesis, thus there may be differences in the results, future research is needed to study the changes in the levels of NLR, RDW and FAR in patients with tuberculosis due to infection by different pathogens, and to improve the sensitivity of NLR, RDW and FAR in the diagnosis of tuberculosis combined with bacterial infections.Further analysis shows that NLR, RDW, and FAR are calculated indicators in routine blood analysis, which are inexpensive, simple and practical, and it can be issued as a new combination of indicators in the blood analysis test report, which can be used in healthcare institutions, especially primary healthcare institutions, to assist in differential diagnosis of bacterial infections and, which is of certain significance for saving medical costs.

In summary, NLR, FAR and RDW indicators have certain clinical reference value for the differential diagnosis of PTB combined with bacterial infection. And the diagnostic value of the three combined tests is higher. Clinicians should closely monitor the changes of NLR, FAR and RDW indexes to reduce the misdiagnosis rate and omission rate, to facilitate the understanding of the patient's disease condition, and to provide reference for the clinical use of drugs.

PTB:pulmonary tuberculosis;NLR: neutrophil-to-lymphocyte ratio;FAR:fibrinogen/albumin ratio;RDW:red blood cell distribution width；AUC:area under the curve;ROC:receiver operating characteristic ;DCAN: diabetic cardiac autonomic neuropathy ;T2DM:type 2 diabetes mellitus

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee of the Sixth People's Hospital of Nantong ( NTLYLL2024009). Patients gave informed consent and signed an informed consent form.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Conflict of Interest Disclosure

The authors have nothing to disclose.

Funding

This study was funded by Scientific Research Fund of Jiangsu Provincial Health Commission, China (H2023093).

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Acknowledgements

Not applicable.

Author details

¹Department of Clinical Laboratory, The Sixth People’s Hospital of Nantong, 500 Yonghe Road,Nantong 226011, Jiangsu, P.R. China.

²Department of Clinical Laboratory,Dalian Municipal Women and Children's Medical Center,Dalian，116012,Liaoning,P.R.China

³Department of Clinical Laboratory, The Ninth People's Hospital of Nantong Wuxi,Wuxi 214121,Jiangsu, P.R. China.

Clinical trial number

Not applicable

Abebe F. Synergy between Th1 and Th2 responses during Mycobacterium tuberculosis infection: A review of current understanding. Int Rev Immunol. 2019;38(4):172-179.
WHO. Global tuberculosis report 2021. Geneva: World Health Organization; 2021.
Yu L, Fu H, Zhang H. The diagnostic value of combined detection of microRNA-155, TNF-α and IL-37 for active pulmonary tuberculosis in the elderly. Am J Transl Res. 2022 Dec 15;14(12):9018-9024.
Yu H, Yang A, Derrick S, Mak JYW, Liu L, Fairlie DP, Cowley S. Artificially induced MAIT cells inhibit M. bovis BCG but not M. tuberculosis during in vivo pulmonary infection. Sci Rep. 2020 Aug 12;10(1):13579.
Ordonez AA, Wang H, Magombedze G, Ruiz-Bedoya CA, Srivastava S, Chen A, Tucker EW, Urbanowski ME, Pieterse L, Fabian Cardozo E, Lodge MA, Shah MR, Holt DP, Mathews WB, Dannals RF, Gobburu JVS, Peloquin CA, Rowe SP, Gumbo T, Ivaturi VD, Jain SK. Dynamic imaging in patients with tuberculosis reveals heterogeneous drug exposures in pulmonary lesions. Nat Med. 2020 Apr;26(4):529-534.
Wang RH, Wen WX, Jiang ZP, Du ZP, Ma ZH, Lu AL, Li HP, Yuan F, Wu SB, Guo JW, Cai YF, Huang Y, Wang LX, Lu HJ. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023 Feb 13;14:1115031.
Zhou XJ, Lu K, Liu ZH, Xu MZ, Li C. U-shaped relationship found between fibrinogen-to-albumin ratio and systemic inflammation response index in osteoporotic fracture patients. Sci Rep. 2024 May 17;14(1):11299.
Chen J, Wu Y, Zhao H, Ruan G, Qin S. Ratio of hemoglobin to red cell distribution width: an inflammatory predictor of survival in AIDS-related DLBCL. Front Immunol. 2024 Feb 15;15:1354325.
Zou H, Liu SH, Yang R, Wu XJ, Cao YP, Huang HF. Combination of Neutrophil-to-Lymphocyte Ratio and Red Cell Distribution Width With Serum Tumor Markers for the Differential Diagnosis of Breast Cancer and its Association With Pathological Features and Molecular Types. Clin Breast Cancer. 2022 Jun;22(4):e526-e535.
Di Raimondo C, Caposiena Caro RD, Spallone D, Silvaggio D, Lombardo P, Del Duca E, Campione E, Spallone G, Bianchi L. Baseline neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) correlate with advanced stages in cutaneous squamous cell carcinoma. Int J Dermatol. 2022 Feb;61(2):175-179.
Fu Y, Yu Y, Zhou Y, Li T, Xie Y, Wang Y, Ran Q, Chen Y, Fan X. The fibrinogen-albumin ratio as a novel prognostic factor for elderly patients with osteosarcoma. Medicine (Baltimore). 2023 Sep 8;102(36):e34926.
Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol. 2023 Jan 26;15(1):13-22.
Bodolea C, Hiriscau EI, Buzdugan EC, Grosu AI, Stoicescu L, Vesa Ș, Cauli O. The Association between Peripheral Blood Cells and the Frailty Syndrome in Patients with Cardiovascular Diseases. Endocr Metab Immune Disord Drug Targets. 2020;20(9):1419-1433. 14.Dogru M, Yesiltepe Mutlu RG. The evaluation of neutrophil-lymphocyte ratio in children with asthma. Allergol Immunopathol (Madr). 2016 Jul-Aug;44(4):292-6.
Xu H, Li W, Mao JH, Pan YX. Association between red blood cell distribution width and Henoch-Schonlein purpura nephritis. Medicine (Baltimore). 2017 Jun;96(23):e7091.
Olson G, Davis AM. Diagnosis and Treatment of Adults With Community-Acquired Pneumonia. JAMA. 2020 Mar 3;323(9):885-886.
Shalahuddin I, Pebrianti S, Eriyani T, Maulana I. Telenursing Intervention for Pulmonary Tuberculosis Patients - A Scoping Review. J Multidiscip Healthc. 2024 Jan 5;17:57-70. 18.Olmo-Fontánez AM, Scordo JM, Schami A, Garcia-Vilanova A, Pino PA, Hicks A, Mishra R, Jose Maselli D, Peters JI, Restrepo BI, Nargan K, Naidoo T, Clemens DL, Steyn AJC, Thacker VV, Turner J, Schlesinger LS, Torrelles JB. Human alveolar lining fluid from the elderly promotes Mycobacterium tuberculosis intracellular growth and translocation into the cytosol of alveolar epithelial cells. Mucosal Immunol. 2024 Apr;17(2):155-168.
Li SJ, Li YF, Song WM, Zhang QY, Liu SQ, Xu TT, An QQ, Liu JY, Li HC. Population aging and trends of pulmonary tuberculosis incidence in the elderly. BMC Infect Dis. 2021 Mar 25;21(1):302.
Attia EF, Pho Y, Nhem S, Sok C, By B, Phann D, Nob H, Thann S, Yin S, Noce R, Kim C, Letchford J, Fassier T, Chan S, West TE. Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study. BMC Pulm Med. 2019 Mar 11;19(1):60.
Chen TC, Lu PL, Lin CY, Lin WR, Chen YH. Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systematic review and meta-analysis. Int J Infect Dis. 2011 Mar;15(3):e211-6.
Shimazaki T, Taniguchi T, Saludar NRD, Gustilo LM, Kato T, Furumoto A, Kato K, Saito N, Go WS, Tria ES, Salva EP, Dimaano EM, Parry C, Ariyoshi K, Villarama JB, Suzuki M. Bacterial co-infection and early mortality among pulmonary tuberculosis patients in Manila, The Philippines. Int J Tuberc Lung Dis. 2018 Jan 1;22(1):65-72.
van der Heijden YF, Maruri F, Blackman A, Holt E, Warkentin JV, Shepherd BE, Sterling TR. Fluoroquinolone exposure prior to tuberculosis diagnosis is associated with an increased risk of death. Int J Tuberc Lung Dis. 2012 Sep;16(9):1162-7.
Carrigan SD, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis. Clin Chem. 2004 Aug;50(8):1301-14.
Avcil S. Evaluation of the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as inflammatory markers in children with attention-deficit hyperactivity disorder. Psychiatry Clin Neurosci. 2018 Jul;72(7):522-530.
Nagai Y, Yokogawa N, Shimada K, Sugii S. Utility of the neutrophil-to-lymphocyte ratio for predicting bacterial infection in patients with rheumatoid arthritis receiving Tocilizumab. Rheumatol Int. 2020 Dec;40(12):2039-2046.
Thanabalasuriar A, Neupane AS, Wang J, Krummel MF, Kubes P. iNKT Cell Emigration out of the Lung Vasculature Requires Neutrophils and Monocyte-Derived Dendritic Cells in Inflammation. Cell Rep. 2016 Sep 20;16(12):3260-3272.
Aktas G, Alcelik A, Tekce BK, Tekelioglu V, Sit M, Savli H. Red cell distribution width and mean platelet volume in patients with irritable bowel syndrome. Prz Gastroenterol. 2014;9(3):160-3.
Hu Y, Shen W, Pan Y. The prognostic value of red blood cell distribution width for pulmonary infection in elderly patients received abdominal surgery with tracheal intubation and general anesthesia. J Natl Med Assoc. 2023 Dec;115(6):519-527.
Ellahony DM, El-Mekkawy MS, Farag MM. A Study of Red Cell Distribution Width in Neonatal Sepsis. Pediatr Emerg Care. 2020 Aug;36(8):378-383.
Jensen T, Kierulf P, Sandset PM, Klingenberg O, Joø GB, Godal HC, Skjønsberg OH. Fibrinogen and fibrin induce synthesis of proinflammatory cytokines from isolated peripheral blood mononuclear cells. Thromb Haemost. 2007 May;97(5):822-9.
Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021 Aug 1;184:857-862.
Zhao S, Yang Z, Yu M, Xiang L, Lv Y, Tian C, Li R. Influence of Fibrinogen/Albumin Ratio and Fibrinogen/Pre-Albumin Ratio on Cardiac Autonomic Neuropathy in Type 2 Diabetes. Diabetes Metab Syndr Obes. 2023 Oct 18;16:3249-3259.
Wang Q, Tu Y, Huang Y, Chen L, Lin Y, Zhan L, He J. High fibrinogen to albumin ratio is associated with hematoma enlargement in spontaneous intracerebral hemorrhage. J Clin Neurosci. 2022 Dec;106:37-42.
Xia W, Li C, Yao X, Chen Y, Zhang Y, Hu H. Prognostic value of fibrinogen to albumin ratios among critically ill patients with acute kidney injury. Intern Emerg Med. 2022 Jun;17(4):1023-1031.

No competing interests reported.

Diagnostic value of neutrophil-to-lymphocyte ratio, fibrinogen-to-albumin ratio and red blood cell distribution width in tuberculosis combined with bacterial infection

Status:

Version 1

Abstract

Figures

Background

Methods

Case selection

Laboratory measurements

Data analysis

Results

Comparison of general clinical data between the two groups

Correlation analysis of blood NLR, FAR, RDW levels and various clinical indicators

Comparison of NLR, FAR and RDW levels between the two groups

Serum NLR, FAR, RDW levels in severe group and non-severe group

Discussion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1