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

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.