Predicting the risk of pulmonary tuberculosis based on the neutrophil-to-lymphocyte ratio at TB screening in HIV-infected individuals

Reiko Miyahara, Surachai Piyaworawong, Vivek Naranbhai, Prarit Prachamat, Prapimporn Kriengwatanapong, Naho Tsuchiya, Jiraporn Wongyai, Surasit Bupachat, Norio Yamada, Surin Summanapan, Surakameth Mahasirimongkol, Hideki Yanai

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17 Citations (Scopus)


Background: The neutrophil to lymphocyte ratio (NL ratio) has been reported to be a predictive biomarker of tuberculosis (TB). We assessed the association between the NL ratio and the incidence of active TB cases within 1 year after TB screening among HIV-infected individuals in Thailand. Methods: A day care center that supports HIV-infected individuals in northernmost Thailand performed TB screening and follow-up visits. We compared the baseline characteristics between the TB screening positive group and the TB screening negative group. The threshold value of NL ratio was determined by cubic-spline curves and NL ratios were categorized as high or low NL ratio. We assessed the association between NL ratio and progression to active TB within 1-year using the Cox-proportional hazard model. Results: Of the 1064 HIV-infected individuals who screened negative for TB at baseline, 5.6% (N = 60) eventually developed TB and 26 died after TB diagnosis. A high NL ratio was associated with a higher risk of TB (adjusted hazard ratio (aHR) 2.19, 95% CI: 1.23-3.90), after adjusting for age, sex, ethnicity, CD4 counts, and other risk factors. A high NL ratio in HIV-infected individuals with normal chest X-ray predicted TB development risk. In particular, a high NL ratio with TB symptoms could predict the highest risk of TB development (aHR 2.58, 95%CI: 1.07-6.23). Conclusions: Our results showed that high NL ratio increased the risk of TB. NL ratio combined with TB symptoms could increase the accuracy of TB screening among HIV-infected individuals.

Original languageEnglish
Article number667
JournalBMC infectious diseases
Issue number1
Publication statusPublished - 2019 Jul 29


  • HIV
  • Lymphocyte
  • Mortality
  • Neutrophil
  • TB screening
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases


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