Correlation between neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and nutritional risk in active pulmonary tuberculosis patients based on propensity score method

doi:10.19982/j.issn.1000-6621.20230056

Abstract

Abstract:

Objective: To investigate the correlation between peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and neutrophil count (NEUT) and the nutritional risk of patients with active pulmonary tuberculosis and to provide basis for clinical assessment of nutritional risk and nutritional intervention. Methods: A retrospective study was conducted to collect clinical baseline data of 786 patients newly diagnosed with active pulmonary tuberculosis who were admitted to the Department of Tuberculosis of the Second Hospital of Nanjing from July 2020 to March 2021. A non-nutritional risk group (score<3) and a nutritional risk group (score≥3) were defined based on the NRS-2002 scores within 24-48 h after admission. The propensity score matching method was used to match the baseline data of the two groups of patients. The correlation between NLR, PLR, and NEUT levels and nutritional risk of the matched patients was evaluated using univariate and binary multivariate logistic regression models. Results: Among the 786 patients, 430 (54.71%) were in the non-nutritional risk group and 356 (45.29%) were in the nutritional risk group. A total of 335 pairs of patients were successfully matched through propensity score matching method. The results of univariate analysis showed that the levels of NLR, PLR and NEUT in the nutritional risk group were 2.86 (1.90, 5.06), 169.09 (124.05, 275.53) and 3600.00 (2690.00, 4920.00) cells/mm³, respectively, which were significantly higher than those in the non-nutritional risk group (2.32 (1.64, 3.65), 146.49 (104.21, 220.19) and 3390.00 (2450.00, 4520.00) cells/mm³, respectively), all the differences were statistically significant (U=-4.021, P<0.001; U=-4.021, P<0.001; U=-2.719, P=0.029). Multivariate logistic regression analysis showed the patients with NLR ≥5 was more likely to develop nutritional risk than patients with NLR<5 (OR (95%CI)=3.061 (1.768-5.300), Wald χ²=17.143, P<0.001). Conclusion: NLR, PLR, and NEUT of peripheral blood immune cells are associated with nutritional risk of pulmonary tuberculosis patients. NLR≥5 is an independent risk factor for nutritional risk of active pulmonary tuberculosis patients, and clinical intervention is needed.

Key words: Tuberculosis, pulmonary, Nutrition surveys, Sickness impact profile, Factor analysis, statistics, Granulocytes

CLC Number:

R521
R151

Chen Yu, Liu Ying, Fang Gang, Hu Chunmei, Yin Guoping. Correlation between neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and nutritional risk in active pulmonary tuberculosis patients based on propensity score method[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 833-838. doi: 10.19982/j.issn.1000-6621.20230056

Figures/Tables 5

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
NEUT≥6000个/mm³	0.339	0.287	1.391	0.708	0.897(0.508~1.585)
NLR≥5	-1.160	0.280	17.143	<0.001	3.061(1.768~5.300)
PLR≥200	-0.115	0.189	0.369	0.145	1.326(0.907~1.938)

References 21

[1]	毛毅, 陈怡, 吴桂辉, 等. 肺结核患者营养风险与临床特征的相关性分析. 结核与肺部疾病杂志, 2020, 1(2):24-28. doi:10.3969/j.issn.2096-8493.2020.01.006. doi: 10.3969/j.issn.2096-8493.2020.01.006
[2]	Sinha P, Davis J, Saag L, et al. Undernutrition and Tuberculosis: Public Health Implications. J Infect Dis, 2019, 219(9):1356-1363. doi:10.1093/infdis/jiy675. doi: 10.1093/infdis/jiy675 pmid: 30476125
[3]	Shah M, Dorman SE. Latent Tuberculosis Infection. N Engl J Med, 2021, 385(24):2271-2280. doi:10.1056/NEJMcp2108501. doi: 10.1056/NEJMcp2108501 URL
[4]	中国人民解放军总医院第八医学中心结核病医学部/全军结核病研究所/全军结核病防治重点实验室/结核病诊疗新技术北京市重点实验室, 《中国防痨杂志》编辑委员会. 结核病重症患者营养评估及营养支持治疗专家共识. 中国防痨杂志, 2022, 44(5): 421-432. doi:10.19982/j.issn.1000-6621.20220041. doi: 10.19982/j.issn.1000-6621.20220041
[5]	Buonacera A, Stancanelli B, Colaci M, et al. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci, 2022, 23(7):3636. doi:10.3390/ijms23073636. doi: 10.3390/ijms23073636 URL
[6]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017肺结核诊断. 2017-11-09.
[7]	中华人民共和国国家卫生和计划生育委员会. WS 196—2017结核病分类. 2017-11-09.
[8]	中国防痨协会. 耐药结核病化学治疗指南(2019年简版). 中国防痨杂志, 2019, 41(10):1025-1073. doi:10.3969/j.issn.1000-6621.2019.10.001. doi: 10.3969/j.issn.1000-6621.2019.10.001
[9]	许静涌, 杨剑, 康维明, 等.营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018).中华临床营养杂志, 2018, 26(3):131-135. doi:10.3760/cma.j.issn.1674-635X.2018.03.001. doi: 10.3760/cma.j.issn.1674-635X.2018.03.001
[10]	Austin PC, Mamdani MM. A comparison of propensity score meth-ods:a case-study estimating the effectiveness of post-AMI statin use. Stat Med, 2006, 25(12):2084-2106. doi:10.1002/sim.2328. doi: 10.1002/sim.2328 pmid: 16220490
[11]	Nakao M, Muramatsu H, Arakawa S, et al. Immunonutritional status and pulmonary cavitation in patients with tuberculosis: A revisit with an assessment of neutrophil/lymphocyte ratio. Respir Investig, 2019, 57(1):60-66. doi:10.1016/j.resinv.2018.08.007. doi: S2212-5345(18)30243-0 pmid: 30528689
[12]	Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulm Med, 2019, 19(1):182. doi:10.1186/s12890-019-0953-0. doi: 10.1186/s12890-019-0953-0 pmid: 31638950
[13]	Icard P, Schussler O, Loi M, et al. Pre-disease and pre-surgery BMI,weight loss and sarcopenia impact survival oresected lung cancer independently of tumor stage. Cancers (Basel), 2020, 12(2):266. doi:10.3390/cancers12020266. doi: 10.3390/cancers12020266 URL
[14]	冯治宇, 谭守勇, 章志俊, 等. 营养支持对伴营养不良的肺结核并肺部感染者的疗效观察. 临床肺科杂志, 2018, 23(7):1169-1171. doi:10.3969/j.issn.1009-6663.2018.07.002. doi: 10.3969/j.issn.1009-6663.2018.07.002
[15]	World Health Organization. Global tuberculosis report 2022. Geneva: World Health Organization, 2022.
[16]	Liu HH, Wang JS, Lin JZ, et al. LPS induced PCT production via TLR-4/NF-кB passway:it is the difference of G^-/G⁺ bacteremia rats. Cytokine, 2021, 137:155317. doi:10.1016/j.cyto.2020.155317. doi: 10.1016/j.cyto.2020.155317 URL
[17]	牛佳慧, 沈国双. 血小板相关参数与恶性肿瘤相关性的研究进展. 医学综述, 2020, 26(1):86-90. doi:10.3969/j.issn.1006-2084.2020.01.017. doi: 10.3969/j.issn.1006-2084.2020.01.017
[18]	Costa MD, Vieira de Melo CY, Amorim AC, et al. Association Between Nutritional Status, Inflammatory Condition, and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia. Nutr Cancer, 2016, 68(7):1108-1114. doi:10.1080/01635581.2016.1206578. doi: 10.1080/01635581.2016.1206578 pmid: 27485861
[19]	马晶晶, 孙波, 郭翔, 等. FAR、NLR、PLR及其联合应用对慢性阻塞性肺疾病急性加重的预测价值. 解放军医学杂志, 2022, 47(6):599-606. doi:10.11855/j.issn.0577-7402.2022.06.0599. doi: 10.11855/j.issn.0577-7402.2022.06.0599
[20]	刘璐, 王希, 张维慧. 中性粒细胞与淋巴细胞比值在肺结核与细菌性社区获得性肺炎鉴别诊断中临床价值. 中国老年学杂志, 2023, 43(3):545-547. doi:10.3969/j.issn.1005-9202.2023.03.010. doi: 10.3969/j.issn.1005-9202.2023.03.010
[21]	罗惠君, 武书果, 杜治祥, 等. 中性粒细胞与淋巴细胞比值预测脓毒症患者预后的价值. 中国当代医药, 2019, 26(27):86-88. doi:10.3969/j.issn.1674-4721.2019.27.025. doi: 10.3969/j.issn.1674-4721.2019.27.025

特征	无营养风险组(430例)	有营养风险组(356例)	统计检验值	P值
年龄(岁)	52.00(33.75,64.00)	53.00(30.00,68.00)	U=-0.194	0.846
性别			χ²=4.958	0.026
男性	248(57.7)	233(65.4)
女性	182(42.3)	123(34.6)
饮酒			χ²=0.728	0.393
否	416(96.7)	348(97.8)
是	14(3.3)	8(2.2)
吸烟			χ²=2.029	0.154
否	410(95.3)	331(93.0)
是	20(4.7)	25(7.0)
其他部位结核病			χ²=1.216	0.270
无	315(73.3)	273(76.7)
有	115(26.7)	83(23.3)
诊断类型			χ²=7.118	0.008
初治	395(91.9)	305(85.7)
复治	35(8.1)	51(14.3)
耐药			χ²=0.101	0.750
否	386(89.8)	322(90.4)
是	44(10.2)	34(9.6)
HIV感染			χ²=0.165	0.685
否	421(97.9)	347(97.5)
是	9(2.1)	9(2.5)
合并糖尿病			χ²=5.180	0.023
否	350(81.4)	311(87.4)
是	80(18.6)	45(12.6)
体质量指数	22.81(21.47,24.27)	19.03(17.93,20.05)	U=-20.225	<0.001

特征	无营养风险组(335例)	有营养风险组(335例)	统计检验值	P值
年龄(岁)	54.00(33.00,66.00)	54.00(30.00,68.00)	U=-0.252	0.801
性别			χ²=0.058	0.809
男性	216(64.5)	213(63.6)
女性	119(35.5)	122(36.4)
饮酒			χ²=0.228	0.633
否	325(97.0)	327(97.6)
是	10(3.0)	8(2.4)
吸烟			χ²=0.001	1.000
否	317(94.6)	317(94.6)
是	18(5.4)	18(5.4)
其他部位结核病			χ²=0.072	0.789
无	250(74.6)	253(75.5)
有	85(25.4)	82(24.5)
诊断类型			χ²=0.064	0.801
初治	301(89.9)	299(89.3)
复治	34(10.1)	36(10.7)
耐药			χ²=0.017	0.896
否	303(90.4)	302(90.1)
是	32(9.6)	33(9.9)
HIV感染			χ²=0.060	0.806
否	327(97.6)	326(97.3)
是	8(2.4)	9(2.7)
合并糖尿病			χ²=0.674	0.412
否	297(88.7)	290(86.6)
是	38(11.3)	45(13.4)

指标	无营养风险组(335例)	有营养风险组(335例)	U值	P值
NEUT(个/mm³)	3390.00(2450.00,4520.00)	3600.00(2690.00,4920.00)	-2.179	0.029
NLR	2.32(1.64,3.65)	2.86(1.90,5.06)	-4.021	<0.001
PLR	146.49(104.21,220.19)	169.09(124.05,275.53)	-4.021	<0.001

编码	因素	赋值	编码	因素	赋值
Y	NRS-2002评分	<3分=0,≥3分=1	X₂	NLR	<5=0,≥5=1
X₁	NEUT(个/mm³)	<6000=0,≥6000=1	X₃	PLR	<200=0,≥200=1