Neutrophyl Lymphocyte Ratio in Tuberculosis Patients and Multi Drug Resistant Tuberculosis Patients

Delores Elisabeth Sormin, Parluhutan Siagian, Bintang YM Sinaga, Putri Chairani Eyanoer


Background: Delayed in diagnosis and treatment of tuberculosis will increase the risk of MDR TB. WHO recommends Xpert MTB/RIF as
diagnostic tools to identify MDR TB. Availability of Xpert MTB/RIF is still limited, another diagnostic tool is needed. Neutrophyl lymphocyte
ratio (NLR) was presumed to be able to identify the probability of MDR TB. The aim of this study is to evaluate the comparison of NLR in tuberculosis
and MDR TB patients.
Methods: This is an analytic descriptive study with case series approach in Adam Malik General Hospital Medan. This study held since
January – December 2015 with number of sample as much as 100 bacteriological confirmed TB patients and 100 MDR TB patients. We
performed leukocyte differential count from peripheral blood examination to obtain NLR
Result: Mean NLR of TB patient 4.62±2.37 and MDR TB 3.28±1.44. There was significant difference of NLR between both groups using
Mann-Whitney test (P=0.001). The cut off value by ROC analysis was 2.91 with sensitivity, specificity, positive predictive value, negative
predictive value and accuracy was 77%, 50%, 60.6%, 68.4% and 63.5% respectively.
Conclusion: There was significant difference of NLR between bacteriological confirmed TB patients and MDR TB patients. Value of NLR <2.91 suggestive for MDR TB. This result may helpful as a screening tool while the gold standard diagnostic is not available.


Neutrophyl lymphocyte ratio; TB; MDR; MDR TB screening

Full Text:



World Health Organization. Course on MDR-TB. France: The World Medical Association; 2013.p.1-220.

Kementerian Kesehatan RI. Pedoman nasional pelayanan kedokteran tata laksana tuberculosis. Jakarta: Kemenkes RI;2013.p.17-25.

Yoon N, Son CH. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013;33:105–10.

Karthik K, Kesavan M, Tamilmahan P, Saravanan M, Dashprakash M. Neutrophils in tuberculosis: will code be unlocked ?. Vet World. 2013;6:118-21.

Kumar S. Update on pathogenesis and management of tuberculosis with drug resistance. Asian Pac J Trop Dis. 2015;5:673-86.

Zhu B, Dheda K, Schwander SK, Zyl-Smit RN, Zhang Y. The immunology of tuberculosis and TB RO: From bench to bedside. Respirology. 2011;15:433–50.

Yin Y, Kuai S, Liu J, Zhang Y, Shan Z, Gu L, et al. Pretreatment neutrophyl-lymphocyte ratio in peripheral blood was associated with pulmonary tuberculosis retreatment. Arch Med Sci. 2017;13:404-11

Li J, Chen Q, Luo X, Hong J, Pan K, Lin X, et al. Neutrophil-to-lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal. 2015;29:437–43.


  • There are currently no refbacks.

Jurnal Respirologi Indonesia
pISSN: 0853-7704 - eISSN: 2620-3162
Address: Jalan Cipinang Bunder No. 19, Cipinang, Pulogadung, Jakarta Timur, DKI Jakarta 13240, Indonesia
Phone: +62-21-2247-4845

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.