Illustration representing the link between tuberculosis, diabetes, and the balance of neutrophil and lymphocyte.

Neutrophil-Lymphocyte Ratio (NLR): A Key to Monitoring TB in Diabetes?

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"New Research Explores NLR as a Marker for Tuberculosis Disease Activity in Patients with Diabetes"

Tuberculosis (TB) remains a major global health challenge, especially when it occurs alongside diabetes mellitus (DM). The co-occurrence of TB and DM, often termed TB-DM, poses unique challenges in diagnosis and management. Patients with both conditions often experience altered immune responses, making it crucial to find reliable markers that can indicate disease activity.

In a recent study presented at Respirology, researchers investigated the potential of using the neutrophil-lymphocyte ratio (NLR) as an indicator of disease activity in TB-DM patients. NLR is a simple, cost-effective marker derived from a routine blood test, reflecting the balance between neutrophils (a type of white blood cell involved in inflammation) and lymphocytes (another type of white blood cell crucial for immune response).

The study aimed to determine if NLR could serve as a valuable tool for clinicians in assessing disease activity in TB-DM patients, potentially leading to more tailored and effective treatment strategies.

NLR: A Promising Marker in TB-DM?

Illustration representing the link between tuberculosis, diabetes, and the balance of neutrophil and lymphocyte.

The study involved a retrospective analysis of data from 181 patients, including 89 with TB-DM and 92 with TB alone. Researchers analyzed blood samples to calculate NLR values and assessed their correlation with disease activity.

Key findings from the study include:

The best cut-off value of NLR was determined to be 2.9.
Patients with an NLR greater than 2.9 were considered to have immunocompromised status.
Patients with an NLR less than 2.9 were considered immunocompetent.
The area under the ROC curve was 0.726 with 95% CI.
At a cut-off of 2.9, NLR displayed a sensitivity of 67%, a specificity of 66%, a positive predictive value (PPV) of 61.7%, a negative predictive value (NPV) of 71.7% and accuracy value was 66.8.

These results suggest that NLR has the potential to differentiate between levels of immune competence in TB-DM patients, providing valuable insights into disease activity.

Implications and Future Directions

The study highlights the potential of NLR as a readily accessible and cost-effective marker for assessing disease activity in TB-DM patients. By identifying patients with compromised immune systems (NLR > 2.9), clinicians may be able to tailor treatment strategies more effectively.

However, the researchers also acknowledge that many factors can affect NLR, indicating that it should be used in conjunction with other clinical and diagnostic parameters. Further research is needed to validate these findings in larger, prospective studies and to explore the underlying mechanisms linking NLR to disease activity in TB-DM.

Ultimately, integrating NLR assessment into the routine management of TB-DM could lead to improved patient outcomes and more personalized approaches to tackling this complex co-infection.

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Everything You Need To Know

What exactly is the Neutrophil-Lymphocyte Ratio (NLR)?

The Neutrophil-Lymphocyte Ratio (NLR) is a simple calculation derived from a routine blood test. It is calculated by dividing the number of neutrophils by the number of lymphocytes. Neutrophils are a type of white blood cell involved in inflammation, while lymphocytes are another type of white blood cell crucial for immune response. The NLR is a cost-effective marker that can be used to assess disease activity in Tuberculosis (TB) patients with Diabetes Mellitus (DM), often termed TB-DM.

Why is the Neutrophil-Lymphocyte Ratio (NLR) important in the context of TB and Diabetes?

The significance of the Neutrophil-Lymphocyte Ratio (NLR) lies in its potential to indicate the level of immune competence in patients with TB-DM. In this context, the study determined a cut-off value of 2.9. Patients with an NLR greater than 2.9 were considered to have an immunocompromised status, while those with an NLR less than 2.9 were considered immunocompetent. The NLR can serve as a valuable tool for clinicians in assessing disease activity in TB-DM patients, potentially leading to more tailored and effective treatment strategies.

What are the implications of having a high Neutrophil-Lymphocyte Ratio (NLR) in TB-DM patients?

The implications of a high Neutrophil-Lymphocyte Ratio (NLR) value (above 2.9) in TB-DM patients are significant. It suggests that the patient's immune system is compromised, indicating increased disease activity and potentially a poorer prognosis. Clinicians can use this information to tailor treatment strategies, potentially intensifying treatment or implementing additional supportive care measures. The study showed that at a cut-off of 2.9, the NLR displayed a sensitivity of 67%, a specificity of 66%, a positive predictive value (PPV) of 61.7%, a negative predictive value (NPV) of 71.7% and accuracy value was 66.8.

How was the Neutrophil-Lymphocyte Ratio (NLR) studied?

The study examined the Neutrophil-Lymphocyte Ratio (NLR) in 181 patients, including 89 with TB-DM and 92 with TB alone. The primary objective was to investigate if the NLR could serve as a valuable tool for assessing disease activity in TB-DM patients. Researchers analyzed blood samples to calculate NLR values and assessed their correlation with disease activity. Key findings, such as the cut-off value of 2.9, were determined to help clinicians in assessing levels of immune competence in patients.

What are the potential future directions for using the Neutrophil-Lymphocyte Ratio (NLR)?

Future research directions involve exploring the widespread implementation of the Neutrophil-Lymphocyte Ratio (NLR) in clinical practice for TB-DM patients. This could include validating the findings in larger and more diverse patient populations, as well as investigating the effectiveness of treatment strategies guided by NLR results. Further studies may also focus on refining the NLR cut-off values and exploring the use of NLR in conjunction with other diagnostic markers to improve the accuracy of disease activity assessment in TB-DM.