Michael Buettcher (Switzerland)
Lucerne Childrens Hospital, LUKS Paediatric Infectious DiseasesAuthor Of 4 Presentations
Welcome to WMW
Introduction
Topic 1 Acute Bone and Joint Infections: Case Discussions Introduction - Part I
DIAGNOSTIC PERFORMANCE IN A MULTICENTRE STUDY USING FULL BLOOD COUNTS FOR THE NEUTROPHIL-TO-LYMPHOCYTE AND MONOCYTE-TO-LYMPHOCYTE RATIO FOR THE DIAGNOSIS OF PAEDIATRIC TUBERCULOSIS
Abstract
Backgrounds:
The monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) are easy to obtain markers from full blood counts. Little is known about the diagnostic accuracy of these ratios in children evaluated for tuberculosis (TB) compared to sick controls.
Methods
Data of two prospective multicentre studies in Switzerland were used: the CITRUS study and the ProPAED study. The CITRUS study included children <18 years with TB exposure (TB-E), TB infection (TB-I) or TB disease (TB-D). The ProPAED study included children 1 month to 18 years of age with fever and lower respiratory tract infection (viral or bacterial) and these were the sick controls (SC).
Results:
A total of 379 children were included in this analysis; 19 with TB-D, 12 with TB-I, 24 TB-E and 324 SC. Median age was 3.08 (IQR [1.37, 6.06]) years and 58% were male. Median NLR was highest in TB-D (2.05 [1.41, 2.64]) and significantly higher compared to children with TB-I (1.08 [0.82, 1.55]), TB-E (0.80 [0.63, 1.33]) and SC (0.31 [0.11, 0.97]) (all p-values < 0.05). Median MLR was similar in TB-D (0.25 [0.18, 0.34]) and SC (0.34 [0.21, 0.58]), but significantly higher in TB-D and TB-I when compared to TB-E (both p-values <0.05). Receiver operating characteristic curves of the ratios were calculated for children with TB-D and SC. NLR and MLR had at cut-off 0.75 and 0.63, an area under the curve of 0.84 and 0.63, sensitivity of 0.94 and 0.94, and specificity of 0.7 and 0.3, respectively. Similar results were obtained after adjustment for age.
Conclusions/Learning Points:
This study shows that NLR and MLR are promising easy-to-obtain diagnostic markers to differentiate children TB-D from non-TB lower respiratory tract infections. These results require confirmation in a larger study sample.