Correlation between neutrophil-to-lymphocyte ratio and molecular test Ct category in patients with drug-resistant tuberculosis
Abstract
Background: Drug-resistant tuberculosis remains a clinical and public health challenge. The neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation, whereas the cycle threshold (Ct) category from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) Ultra reflects semiquantitative molecular bacillary load. Evidence linking both parameters in drug-resistant tuberculosis remains limited.
Objective: To analyze the correlation between blood NLR and molecular test Ct category in patients with drug-resistant tuberculosis.
Methods: This analytic observational study with a cross-sectional design was conducted at Dr. H. A. Rotinsulu Lung Hospital, Bandung, from January to November 2024. Twenty-nine adult patients with drug-resistant tuberculosis who had complete hematology and Xpert MTB/RIF Ultra results were selected using purposive sampling. NLR was calculated from differential leukocyte counts. Ct was grouped into high, medium, and low categories. Data were analyzed using descriptive statistics, Spearman correlation, and the Kruskal-Wallis test.
Results: Of 29 patients, 19(66%) were male, and 22(76%) of the whole sample had elevated NLR. Ct categories consisted of high in 15 patients, medium in 3 patients, and low in 11 patients. Mean NLR was 6.76 in the high Ct group, 3.50 in the medium group, and 5.49 in the low group. Spearman analysis showed a very weak and non-significant positive correlation between NLR and Ct category (r=0.101; p=0.300). The Kruskal-Wallis test also showed no significant NLR difference across Ct categories (H=1.667; p=0.435).
Conclusion: NLR was not significantly correlated with Ct category and did not differ significantly across Ct groups. NLR should be interpreted as an adjunct inflammatory marker, not as a substitute for molecular bacteriological assessment in drug-resistant tuberculosis.
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