 |
|
ORIGINAL ARTICLE |
|
| Year : 2014 | Volume
: 9
| Issue : 4 | Page : 232-235 |
|
| Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis |
|
|
Sinem Iliaz1, Raim Iliaz2, Gonenc Ortakoylu1, Ayse Bahadir1, Belma Akbaba Bagci1, Emel Caglar1
1 Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Zeytinburnu, Turkey
2 Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Fatih, Istanbul, Turkey
| Date of Submission | 12-Mar-2014 |
| Date of Acceptance | 05-May-2014 |
| Date of Web Publication | 4-Sep-2014 |
Correspondence Address:
Sinem Iliaz
Istanbul Yedikule Gogus Hastaliklari ve Gogus Cerrahisi Egitim ve Arastirma Hastanesi, Kazlicesme Mah, Belgrat Kapi Yolu No: 1, Posta kodu: 34020, Zeytinburnu, Istanbul
Turkey
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1817-1737.140135
|
|
 Abstract | | |
Introduction: The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated.
Objective: The aim of our study is to investigate the value of neutrophil/lymphocyte ratio (NLR) as a possible marker in differentiating sarcoidosis and tuberculosis.
Materials and Methods: In our study, 51 acid-fast bacilli (AFB) positive and/or culture-positive patients with pulmonary tuberculosis, 40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. In our study, information was collected retrospectively based on hospital records.
Results: Leukocyte and neutrophil counts, NLR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were significantly higher, and albumin was significantly lower in the tuberculosis group compared with sarcoidosis (for all parameters P < 0.001). The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% positive predictive value (PPV), 75% negative predictive value (NPV), and area under the curve (AUC) was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%.
Conclusion: NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue is needed.
Keywords: Granulomatous inflammation, neutrophil-lymphocyte ratio, sarcoidosis, tuberculosis
How to cite this article:
Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med 2014;9:232-5 |
How to cite this URL:
Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med [serial online] 2014 [cited 2023 Mar 24];9:232-5. Available from: https://www.thoracicmedicine.org/text.asp?2014/9/4/232/140135 |
Tuberculosis is a common infectious disease in the world. Therefore, it has a very important place in differential diagnosis of pulmonary and extrapulmonary granulomatous diseases. In order to diagnose the disease, pathogen are required to demonstrate. Because this is not always possible, the diagnosis can be made based on clinical, pathological and radiological findings. The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. In sarcoidosis, symptoms such as fever, fatigue, weight loss and cough may be present, similar to tuberculosis, thus making clinical differentiation of sarcoidosis and tuberculosis difficult. [1] As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated.
The neutrophil/lymphocyte ratio (NLR) is determined by dividing the absolute count of neutrophils by the number of lymphocytes in the complete blood count. NLR has emerged as a new marker of inflammation. [2],[3],[4],[5] Studies are available showing the relationship between NLR and prognosis in lung cancer and colorectal cancer. [6],[7],[8],[9] In addition, high-NLR in acute coronary syndrome and patients undergoing coronary invasive procedures has been shown to be associated with poor prognosis. [10],[11] Studies in the field of chest diseases are usually focused on lung cancer. There are few studies about chronic obstructive pulmonary disease (COPD), tuberculosis and pneumonia. [12],[13],[14] The aim of our study is to investigate the value of NLR as a possible marker in differentiating sarcoidosis and tuberculosis.
| Materials and Methods | |  |
In our study 51 acid-fast bacilli (AFB) positive and/or culture-positive patients with pulmonary tuberculosis, 40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. All patients diagnosed as pulmonary tuberculosis and sarcoidosis in our Pulmonology clinic in 2012-2013 were included. Exclusion criteria were defined as: Acute coronary syndrome, presence of active malignancy, hematologic disease, steroid use, having immunosuppressive therapy, the presence of other active infections. Forty-three asymptomatic patients who were admitted to the internal medicine out-patient clinic for routine health control were included as the control group. Patients who had infectious, inflammatory and malignant pathologies were excluded.
In our study, information was collected retrospectively based on hospital records. We recorded the patients' age, sex, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count, and serum albumin levels. The NLR was obtained by dividing the absolute number of neutrophils by lymphocytes in complete blood count. An automatic blood count device was used for the complete blood count. Pre-treatment acute-phase reactant levels were recorded from medical records.
Statistical analyses were performed using the SPSS (Statistical Package for Social Sciences) 15.0 software package. Descriptive values were given as mean and standard deviation. Categorical variables were expressed as the number of cases and the percentage value. Continuous variables were analyzed using Kolmogorov-Smirnov and Shapiro-Wilk tests to determine whether there was normal distribution. The Student's t-test and Mann-Whitney-U test were used depending on the situation of the variables i. e. normally distributed or not. The comparison of categorical variables were performed using Chi-square and Fisher's exact tests. Spearman's correlation test was used to analyse the relationship between NLR and other inflammatory markers. In order to determine the cut-off value of NLR, ROC (receiver operating characteristics) curve analysis was used. Statistical significance was set as P < 0.05.
| Results | | |
A total of 134 patients were included into the study. Tuberculosis group consisted of 51 patients. Twenty-nine (56.9%) of them were men and 22 (43.1%) were female. The mean age was 45.5 ± 12.2 years. The sarcoidosis group consisted of 40 patients. Of these, 8 patients (20%) were men and 32 (80%) were female. The mean age of the sarcoidosis group was 45.9 ± 11.5 years. The control group consisted of 43 patients, 18 patients (41.9%) were men and 25 (58.1%) were female. The mean age was 44.1 ± 13.9 years. The mean age was similar in all three groups (P > 0.05). The tuberculosis and control groups were similar in terms of sex (P > 0.05); however, the majority of the sarcoidosis group were female. The demographic and laboratory characteristics of the patients are summarized in [Table 1].
In the evaluation of patients with tuberculosis, NLR showed positive correlation with CRP (r = 0.500, P < 0.001). Also, there was a positive correlation between CRP and ESR in this group (r = 0.500, P = 0.009). There were no further correlations between other inflammatory markers in the tuberculosis group. In the evaluation of patients with sarcoidosis, a positive correlation was found between CRP and ESR (r = 0.506, P = 0.008). There were no other correlations between inflammatory markers in the sarcoidosis group.
When the tuberculosis and control groups were compared with each other, a statistically significant difference was found between the groups in terms of leukocyte, neutrophil, lymphocyte counts, ESR, CRP, serum albumin and NLR (for all parameters P < 0.001). Neutrophils, white blood cells (WBC), ESR, and CRP were higher in the tuberculosis group. On the other hand, lymphocytes and albumin were lower in this group compared with controls. The NLR was significantly higher in the tuberculosis group in parallel with the increase in neutrophils and the decline in lymphocytes (P < 0.001) [Table 1]. In order to distinguish cases of tuberculosis from the control group, the most appropriate cut-off value was 2.16. For this cut-off value, NLR had sensitivity of 88% and specificity of 80%, positive predictive value (PPV) of 82%, negative predictive value (NPV) of 87% and area under the curve (AUC) was 0.921. According to this cut-off value, accuracy of the NLR test for distinguishing tuberculosis from the control group was 84%. See [Table 2] for other markers. | Table 2: ROC analysis results and accuracy rates of NLR and other infl ammatory markers in detection of tuberculosis among tuberculosis and control groups
Click here to view |
When the sarcoidosis and control groups were compared, neutrophil count, NLR and CRP were significantly higher, and lymphocytes were significantly lower in the sarcoidosis group (respectively P = 0.04, P < 0.001, P < 0.001, P = 0.005). There were no statistically significant differences between the groups for total leukocyte count, ESR and albumin (P > 0.05) [Table 1]. The value of 1.88 was determined as the most appropriate cut-off value for NLR for the distinction of sarcoidosis and controls. For this cut-off value, NLR had a sensitivity of 73%, specificity of 74%, PPV of 68%, NPV of 71%, and AUC was 0.790. The accuracy of NLR test for this cut-off value was 70% for distinction of sarcoidosis and controls. See [Table 3] for the other markers. | Table 3: ROC analysis results and accuracy rates of NLR and other infl ammatory markers in detection of sarcoidosis among sarcoidosis and control groups
Click here to view |
Leukocyte and neutrophil counts, NLR, ESR, and CRP were significantly higher, and the albumin was significantly lower in the tuberculosis group compared with sarcoidosis (for all parameters P < 0.001). No significant difference was observed in the lymphocyte count in this comparison (P > 0.05) [Table 1]. The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% PPV, 75% NPV, and AUC was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%. See [Table 4] for the other markers. | Table 4: ROC analysis results and accuracy rates of NLR and other infl ammatory markers in detection of tuberculosis among sarcoidosis and tuberculosis groups
Click here to view |
| Discussion | | |
Many publications have been written on the relationship between prognosis and NLR as a marker of inflammation. The value of NLR has been studied in cardiovascular disease, chronic renal disease, malignancies, osteoporosis and Alzheimer's disease. [6],[7],[8],[9],[10],[11],[15],[16],[17] However, the most popular area of study in pulmonary medicine is its relationship with prognosis of lung cancer and mesothelioma. [6],[7],[18],[19] In non-small cell lung cancer and mesothelioma, high NLR was associated with poor prognosis. In other areas of respiratory medicine, there are very few studies. One of these areas is COPD. In the study of Gunay et al., NLR has been shown to be higher in acute exacerbation of COPD compared with both stable COPD and healthy controls. In this study, NLR was correlated with CRP in COPD and it was suggested that NLR could be used as a new marker of inflammation in COPD. [12] Few studies are available evaluating the value of NLR in infectious lung diseases. According to the study of Yoon et al., NLR can be used for the discrimination of tuberculosis and community acquired pneumonia. [13] De Jager et al.,'s study suggested that NLR calculated on admission to the emergency room provided a better prediction for the course of community acquired pneumonia. [14]
Tuberculosis/sarcoidosis distinction is very difficult in some cases and there is a need for new markers in this area. Sometimes it is not even possible to distinguish clinically or pathologically. In this situation, a patient should be started on anti-tuberculosis therapy and closely monitored. Our study was conducted to determine if NLR contributes to the differentiation of tuberculosis and sarcoidosis, and if NLR value differs in disease groups with respect to the control group.
Gunay et al., showed a positive correlation between CRP and NLR in COPD patients. [12] Similarly, there was a positive correlation between NLR and CRP in the tuberculosis group of our study. The NLR in tuberculosis and sarcoidosis patients were significantly higher than the control group. In the comparison of tuberculosis and sarcoidosis, a cut-off value of NLR ≥ 2.55 can differentiate tuberculosis with an accuracy rate of 76%.
The neutrophil/lymphocyte ratio is a marker that can be calculated easily from a routine complete blood count. It does not introduce additional workload or cost to the clinician or the laboratory. It is easily repeatable. With present and ongoing studies, NLR use is becoming increasingly common in malignant and non-malignant diseases. Its success in predicting prognosis is emphasized in many studies. [6],[7],[8],[9],[10],[11] Besides, its beneficial role in diagnosis needs more studies. Limitations of our study are being retrospective, based on hospital archive, not having a large sample size and giving a 69% specificity for distinguishing tuberculosis and sarcoidosis. In order to evaluate clinical relevance of NLR in sarcoidosis and tuberculosis, more studies with larger sample size are needed. Our study leads a new discussion area on role of NLR in granulomatous lung diseases.
In conclusion, NLR has attracted attention as a new inflammatory marker. Different usage areas are being explored. To date, the difficulty in differentiating sarcoidosis and tuberculosis remains. In our study, NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue are needed.
| References | | |
| 1. | Telenti A, Hermans PE. Idiopathic granulomatosis manifesting as fever of unkown origin. Mayo Clin Proc 1989;64:44-50. 
|
| 2. | Jilma B, Blann A, Pernerstorfer T, Stohlawetz P, Eichler HG, Vondrovec B, et al. Regulation of adhesion molecules during human endotoxemia. No acute effects of aspirin. Am J Respir Crit Care Med 1999;159:857-63.
|
| 3. | Dionigi R, Dominioni L, Benevento A, Giudice G, Cuffari S, Bordone N, et al. Effects of surgical trauma of laparoscopic vs. open cholecystectomy. Hepatogastroenterology 1994;41:471-6.
|
| 4. | O′Mahony JB, Palder SB, Wood JJ, McIrvine A, Rodrick ML, Demling RH, et al. Depression of cellular immunity after multiple trauma in the absence of sepsis. J Trauma 1984;24:869-75.
[PUBMED] |
| 5. | Zahorec R. Ratio of neutrophil to lymphocyte counts - rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5-14.
[PUBMED] |
| 6. | Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 2009;137:425-8.
|
| 7. | Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012;14:864-9.
|
| 8. | Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-4.
|
| 9. | Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 2008;34:55-60.
|
| 10. | Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7.
|
| 11. | Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006;97:993-6.
|
| 12. | Gunay E, Sarýnç Ulasli S, Akar O, Ahsen A, Gunay S, Koyuncu T, et al . Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: A retrospective study. Inflammation 2014;37:374-80.
|
| 13. | Yoon NB, Son C, Um SJ. 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.
|
| 14. | de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One 2012;7:e46561.
|
| 15. | Ahsen A, Ulu MS, Yuksel S, Demir K, Uysal M, Erdogan M, et al. As a new inflammatory marker for familial Mediterranean fever: Neutrophil-to-lymphocyte ratio. Inflammation 2013;36:1357-62.
|
| 16. | Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101:747-52.
|
| 17. | Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013;17:391-6.
|
| 18. | Kao SC, Vardy J, Harvie R, Chatfield M, van Zandwijk N, Clarke S, et al. Health-related quality of life and inflammatory markers in malignant pleural mesothelioma. Support Care Cancer 2013;21:697-705.
|
| 19. | Pinato DJ, Mauri FA, Ramakrishnan R, Wahab L, Lloyd T, Sharma R. Inflammation-based prognostic ýndices in malignant pleural mesothelioma. J Thorac Oncol 2012;7:587-94.
|
[Table 1], [Table 2], [Table 3], [Table 4] |
|
| This article has been cited by | | 1 |
Difference between the blood samples of patients with bone and joint tuberculosis and patients with tuberculosis studied using machine learning |
|
| Zhen Ye, Jichong Zhu, Chong Liu, Qing Lu, Shaofeng Wu, Chenxing Zhou, Tuo Liang, Jie Jiang, Hao Li, Tianyou Chen, Jiarui Chen, Guobing Deng, Yuanlin Yao, Shian Liao, Chaojie Yu, Xuhua Sun, Liyi Chen, Hao Guo, Wuhua Chen, Wenyong Jiang, Binguang Fan, Xiang Tao, Zhenwei Yang, Wenfei Gu, Yihan Wang, Xinli Zhan | | Frontiers in Surgery. 2023; 9 | | [Pubmed] | [DOI] | | | 2 |
Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio According to the Radiologic Severity of Mycobacterium avium Complex Pulmonary Disease |
|
| Mi-Ae Kim, Yea Eun Park, Yong Pil Chong, Tae Sun Shim, Kyung-Wook Jo | | Journal of Korean Medical Science. 2022; 37(40) | | [Pubmed] | [DOI] | | | 3 |
The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: cross-sectional study |
|
| Sumeyye Alparslan Bekir, Esin Sonkaya, Fatma Ozbaki, Selma Aydogan Eroglu, Lale Sertcelik, Dildar Duman, Murat Kavas, Meltem Agca, Ipek Erdem, Ipek Ozmen, Sibel Boga, Armagan Hazar, Tulin Sevim, Hatice Turker, Eylem Tuncay, Sinem Gungor, Zuhal Karakurt | | Postgraduate Medicine. 2022; | | [Pubmed] | [DOI] | | | 4 |
C-reactive protein Lymphocyte Ratio in the Diagnosis of Pulmonary Tuberculosis |
|
| Ibrahim KOÇ, Yusuf Taha GULLU | | Turkish Journal of Internal Medicine. 2022; | | [Pubmed] | [DOI] | | | 5 |
Combination of prealbumin and tuberculosis-specific antigen/phytohemagglutinin ratio for discriminating active tuberculosis from latent tuberculosis infection |
|
| Ying Luo, Ying Xue, Xu Yuan, Qun Lin, Guoxing Tang, Liyan Mao, Huijuan Song, Feng Wang, Ziyong Sun | | International Journal of Clinical Practice. 2021; 75(4) | | [Pubmed] | [DOI] | | | 6 |
Combination of Blood Routine Examination and T-SPOT.TB Assay for Distinguishing Between Active Tuberculosis and Latent Tuberculosis Infection |
|
| Ying Luo, Guoxing Tang, Xu Yuan, Qun Lin, Liyan Mao, Huijuan Song, Ying Xue, Shiji Wu, Renren Ouyang, Hongyan Hou, Feng Wang, Ziyong Sun | | Frontiers in Cellular and Infection Microbiology. 2021; 11 | | [Pubmed] | [DOI] | | | 7 |
Lymphocyte-Related Immunological Indicators for Stratifying Mycobacterium tuberculosis Infection |
|
| Ying Luo, Ying Xue, Guoxing Tang, Yimin Cai, Xu Yuan, Qun Lin, Huijuan Song, Wei Liu, Liyan Mao, Yu Zhou, Zhongju Chen, Yaowu Zhu, Weiyong Liu, Shiji Wu, Feng Wang, Ziyong Sun | | Frontiers in Immunology. 2021; 12 | | [Pubmed] | [DOI] | | | 8 |
Prognostic value of inflammatory markers determined during diagnosis in patients with sarcoidosis: chronic versus remission |
|
| Sumeyye Alparslan Bekir, Murat Yalcinsoy, Sinem Gungor, Eylem Tuncay, Fatma Tokgoz Akyil, Pakize Sucu, Dilek Yavuz, Sibel Boga | | Revista da Associação Médica Brasileira. 2021; 67(11): 1575 | | [Pubmed] | [DOI] | | | 9 |
Nötrofil Lenfosit Orani ve Monosit Lenfosit Orani Çocukluk Çagi Tuberkülozu Tanisinda Kullanilabilir mi? |
|
| Sefika ELMAS BOZDEMIR, Humeyra ASLANER | | Online Türk Saglik Bilimleri Dergisi. 2021; | | [Pubmed] | [DOI] | | | 10 |
Composite Bacterial Infection Index and Serum Amyloid A Protein in Pulmonary Tuberculosis Patients and their Household Contacts in Makassar |
|
| Irda Handayani, Muhammad Nasrum Massi, Yanti Leman, Rosdiana Natzir, Ilhamjaya Patellongi, Subair Subair, Najdah Hidayah, Ayu Andini Wulandari, Handayani Halik | | Open Access Macedonian Journal of Medical Sciences. 2021; 9(B): 557 | | [Pubmed] | [DOI] | | | 11 |
The potential of CBC-derived ratios (monocyte-to-lymphocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte) to predict or diagnose incident TB infection in Tanzanian adolescents |
|
| Christiaan A. Rees, Dwan B. Pineros, Maryam Amour, Patricia Munseri, Jamila Said, Albert Magohe, Mecky Matee, Kisali Pallangyo, C. Fordham von Reyn | | BMC Infectious Diseases. 2020; 20(1) | | [Pubmed] | [DOI] | | | 12 |
Multi-parameter flow cytometry immunophenotyping distinguishes different stages of tuberculosis infection |
|
| Olivia Estévez, Luis Anibarro, Elina Garet, Amparo Martínez, Alberto Pena, Laura Barcia, Mercedes Peleteiro, África González-Fernández | | Journal of Infection. 2020; 81(1): 57 | | [Pubmed] | [DOI] | | | 13 |
Changes in cytokine responses to TB antigens ESAT-6, CFP-10 and TB 7.7 and inflammatory markers in peripheral blood during therapy |
|
| Ah Young Leem, Joo Han Song, Eun Hye Lee, Hyejon Lee, Bora Sim, Song Yee Kim, Kyung Soo Chung, Eun Young Kim, Ji Ye Jung, Moo Suk Park, Young Sam Kim, Joon Chang, Young Ae Kang | | Scientific Reports. 2018; 8(1) | | [Pubmed] | [DOI] | | | 14 |
Inflammation responses in patients with pulmonary tuberculosis in an intensive care unit |
|
| Qiu-Yue Liu, Fen Han, Li-Ping Pan, Hong-Yan Jia, Qi Li, Zong-De Zhang | | Experimental and Therapeutic Medicine. 2018; | | [Pubmed] | [DOI] | | | 15 |
Can Ratio of Neutrophil-Tolymphocyte Count and Erythrocyte Sedimentation Rate in Diabetic Foot Infection Predict Osteomyelitis and/or Amputation? |
|
| Oktay Yapici, Hande Berk, Nefise Öztoprak, Derya Seyman, Alper Tahmaz, Alparslan Merdin | | Hematology Reports. 2017; 9(1): 19 | | [Pubmed] | [DOI] | | | 16 |
Predictive Contribution of Neutrophil/Lymphocyte Ratio in Diagnosis of Brucellosis |
|
| Serdar Olt,Hasan Ergenç,Seyyid Bilal Açikgöz | | BioMed Research International. 2015; 2015: 1 | | [Pubmed] | [DOI] | | | 17 |
Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy |
|
| Fatih Mehmet Yazar,Murat Bakacak,Arif Emre,Aykut Urfalioglu,Salih Serin,Emrah Cengiz,Ertan Bülbüloglu | | The Kaohsiung Journal of Medical Sciences. 2015; 31(11): 591 | | [Pubmed] | [DOI] | | | 18 |
A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery |
|
| Osman Fatih Boztepe,Taylan Gün,Meltem Demir,Özer Erdem Gür,Deniz Ozel,Harun Dogru | | European Archives of Oto-Rhino-Laryngology. 2015; | | [Pubmed] | [DOI] | | | 19 |
A novel predictive marker for the viscosity of otitis media with effusion |
|
| Osman Fatih Boztepe,Meltem Demir,Taylan Gün,Nagihan Bilal,Nuray Akmese Ensari,Harun Dogru | | International Journal of Pediatric Otorhinolaryngology. 2015; 79(12): 2355 | | [Pubmed] | [DOI] | |
|
|
|
|
|
|
|
|
|
