Pre-treatment blood cell counts and inflammatory markers predict the radiologic severity of post-tuberculosis lung disease.

BACKGROUND: Patients with pulmonary tuberculosis (TB) achieve microbiological cures following anti-TB treatment; however, post-tuberculosis lung disease (PTLD) persists in some. This study aimed to evaluate whether pre-treatment blood cell count indicators and inflammatory markers could predict the radiologic severity of PTLD.

METHODS: Overall, 169 patients with pulmonary TB diagnosed at Beijing Chest Hospital were prospectively enrolled. Baseline data were recorded and chest computed tomography (CT) images after the completion of anti-TB treatment were scored from 0 to 24 using a validated system. Patients were classified into mild and severe lung damage groups according to the median value of post-treatment chest CT score. Linear regression and logistic regression analyses were performed to assess the association between baseline inflammatory markers and post-treatment radiologic severity.

RESULTS: The overall mean age was 39.34 ± 15.37 years; 72.8% were men and 49.7% had a smoking history. The median CT score at the treatment end was 9 (interquartile range: 6–15). Significant positive correlations were observed between post-treatment CT scores and baseline erythrocyte sedimentation rate (ESR) (β = 0.040), high-sensitivity C-reactive protein (hs-CRP) (β = 0.030), white blood cell (WBC) count (β = 0.269), neutrophil percentage (β = 0.121) and count (β = 0.330), monocyte count (β = 4.169), and neutrophil-to-lymphocyte ratio (NLR) (β = 0.272). Negative correlations were identified with hemoglobin (Hb) (β = -0.070) and lymphocyte percentage (β = -0.138). Multivariable logistic regression confirmed the predictors.

CONCLUSION: Pre-treatment ESR, hs-CRP, WBC count, Hb, neutrophil percentage and count, lymphocyte percentage, monocyte count and NLR are predictive of post-treatment radiologic severity. These findings highlight the potential for using readily available clinical markers to identify high-risk patients and guide personalized management strategies.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-025-11782-w.