Diagnostic potential of inflammatory markers in tuberculous pleural effusion: a prospective tertiary hospital study

Abstract

Introduction

Background and Objectives

India is an endemic country for TB Tuberculosis(TB), with the pleura being the most common extra pulmonary site

affected, followed by lymph nodes. Diagnosing EPTB Extrapulmonary Tuberculosis( EPTB)is as crucial as treating

it, since many cases are often neglected or improperly managed outside medical college hospitals. The objective of

my study is to compare the diagnostic accuracy of the Neutrophil lymphocyte ratio (NLR) with that of isolated

pleural fluid ADA Adenosine deaminase(ADA) levels in lymphocyte predominant effusions.

Methods

This is a prospective study conducted after ethical clearance and collected patient data, including demographics,

vital signs, laboratory test results, and imaging. Under aseptic conditions diagnostic and and therapeutic

pleurocentesis was performed for the patients after their informed consent. Pleural fluid for NLR was compared

with standard ADA alone in high pre-test probability (exudative lymphocytic predominant). Patients were followed

up after a month of starting ATT ( Anti Tuberculosis Treatment ), to assess clinical response by repeat imaging.

Results

A total of 54 patients among 80 patients who met the inclusion criteria ,with exudative pleural effusion was included

in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculous pleural effusion.

NLR cut off was plotted with Receiver Operating Characteristic (ROC) curve with sensitivity and specificity

calculated.

Conclusion

The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated

haematological parameter when tested with ADA, synergistically increases the diagnostic accuracy.