The utility and validity of immunological, inflammatory, and nutritional-based scores and indices in active Pulmonary Tuberculosis

Abstract

Purpose: The host immune/inflammatory cells play an important role in Mycobacterium tuberculosis (TB) evolution. We aimed to validate the utility of immunological, inflammatory, and nutritional-based indices in active pulmonary TB (APTB). Patients and methods: fifty PTB patients with fifty healthy subjects were included. Sputum examined for acid-fast bacilli and peripheral blood samples collected to assess inflammatory indices as [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), neutrophil-platelet score (NPS), body mass index (BMI), ESR, C-reactive protein (CRP) and/or albumin-based as advanced lung cancer inflammation index (ALI), prognostic nutritional index (PNI). Results: Patients had a significantly lower BMI, Hb, lymphocyte, MPV, WBC/MPV, MLR, LMR, albumin, PNI, ALI, (P =0.00001) and significantly higher neutrophil, monocyte, RDW, NLR, PLR, ESR, CRP (P =0.00001). The increase in mycobacterial load significantly associated with decreased BMI, albumin, PNI, ALI and increased ESR, neutrophil count, CRP, CRP/albumin ratio, GPS, mGPS, and PLR. ROC curve analysis revealed that ESR, RDW, BMI, MLR, ALI, Hb, MPV, monocyte, NLR, PLR, albumin, and lymphocyte, had great decision power that could differentiate APTB patients from controls. The best cutoff value MPV (8.08 fL), albumin (3.99 g/dl), BMI (23.67 kg/m2), Hb (12.3 g/dl), and lymphocyte (2600×109/l) RDW (14.8%), monocyte (550×109/l), and ALI (53%) (P =0.0001). Regression analysis approved that MPV, albumin level; BMI, Hb, lymphocyte, and ALI had the highest odds ratio as the prognostic value of APTB Conclusion: the immunological, inflammatory, and nutritional-based scores are valuable prognostic tools that reflect the degree of host inflammatory activity that promotes disease progression.