Retrospective Study: Neutrophil-to-Lymphocyte Ratio for Distinguishing Pulmonary Tuberculosis and Community-Acquired Pneumonia in Children

Wina Djiu; Retno Asih Setyoningrum; Mia Ratwita Andarsini

doi:10.23750/abm.v96i5.16991

Authors

Wina Djiu Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia https://orcid.org/0009-0000-1682-0335
Retno Asih Setyoningrum Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia https://orcid.org/0000-0002-4194-6869
Mia Ratwita Andarsini Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia https://orcid.org/0000-0003-1431-5137

Keywords:

NLR, tuberculosis, community-acquired pneumonia

Abstract

Background and aim: Tuberculosis and pneumonia remain among the top ten causes of death in children under five. Clinical manifestations of pulmonary TB in children are mostly nonspecific and resemble acute pneumonia. The paucibacillary nature of TB in children contributes to diagnostic challenges. The neutrophil-to-lymphocyte ratio (NLR) is a straightforward biomarker that connects the innate and adaptive immune systems. This study aims to analyze the effectiveness of the NLR in distinguishing pulmonary tuberculosis (TB) from community-acquired pneumonia (CAP) in children.

Methods: This research is a retrospective case-control observational study based on medical record data of pediatric subjects with pulmonary TB or CAP treated at RSUD Dr. Soetomo. Characteristics and laboratory data were collected from medical records.

Results: A total of 50 subjects with pulmonary TB and 50 subjects with CAP demonstrated a significantly lower NLR in the pulmonary TB group (median 1.31; 0.23–5.62) vs. the CAP group (median 3.98; 1.19–53.51), p <0.001. The NLR differed significantly based on age. Pulmonary TB subjects aged <5 years old had a lower NLR (median 1.18; 0.23-5.00) compared to those >5 years old (median 2.89; 1.16-5.62) with p <0.001. Community-acquired pneumonia subjects aged <5 years old also had a lower NLR (median 3.79; 1.19-10.69) vs. >5 years old (median 6.79; 1.37-53.51) with p = 0.048. The cut-off <2.06 demonstrated good performance for differentiating pulmonary TB from CAP with high sensitivity (92%) and good specificity (68%).

Conclusions: The NLR is a useful biomarker to distinguish pulmonary TB from CAP in limited resource settings.

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