Diagnostic value of neutrophil-to-lymphocyte ratio in patients with leprosy reactions

Abstract

Introduction: Leprosy reactions, classified as type 1 and type 2 reactions, are acute clinical conditions of exacerbation of localized or systemic inflammatory response inpatients with leprosy. No laboratory biomarker is available to predict the emergence of these reactions. Neutrophil-to-lymphocyte ratio (NLR) is an accurate biomarker for diagnosis and prognosis of various inflammatory and neoplastic diseases.Objective: This study aimed to investigate the accuracy of the NLR in the diagnosis of leprosy reactions. Materials and methods: NLR was calculated for all patients and a receiver operating characteristic curve (ROC) were generated to identify the NLR cut-off point. Results: A total of 123 patients with leprosy were included, 98 with leprosy reactions of which 56 (45.5%) had type 1 and 42 (34.1%) with type 2. Mean NLR was higher among patients with reactions than among those without. It was also statistically higher among patients with type 2 reactions than in those with type 1 reactions. Receiver operating characteristic curves were generated to identify the NLR cut-off point. The area under the ROC curve was 0.794 for diagnosis of any leprosy reaction and 0.796 for the diagnosis of type 2 reaction. The NLR cutoff points for diagnosis of any leprosy reaction and for type 2 reaction were 2.75 (sensitivity 61.0%, specificity 92.0%, accuracy 77.0%) and 2.95 (sensitivity 81.0%, specificity 74.0%, accuracy 78.0%), respectively. Conclusion: These results suggest that NLR could be a potential biomarker for diagnosis of leprosy reaction and useful for discriminating patients with type 2 reactions from those with type 1 leprosy reactions.

COVID-19, leprosy, and neutrophils

“…Similar to COVID-19, patients with ENL present neutrophilia and high NLR [ 22 ]. ENL-circulating neutrophils present higher expression of CD64, a neutrophilic activation marker, in comparison to those found in the phenotypes in other clinical leprosy forms [ 18 ].…”

Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

“…As is current practice in sepsis (Farkas, 2020;Goldberg et al, 2020), tuberculosis (Abakay et al, 2015), and reactive forms of leprosy (Gomes et al, 2020), biomarkers are being widely discussed and proposed as tests that complement the clinical decision making to predict the presence of severity in infections (Jager et al, 2012). Among the various parameters related to leukocytes in the bloodstream, the neutrophil/lymphocyte ratio (NLR) stands out for being a biomarker that is easily obtained and available in clinical practice, in addition to being significantly associated with systemic inflammation (Benites-Zapata et al, 2015).…”

“…Similar to other infectious diseases like sepsis (Farkas, 2020;Goldberg et al, 2020), tuberculosis (Abakay et al, 2015), and reactive forms of leprosy (Gomes et al, 2020), biomarkers have been widely discussed and proposed as complementary tests to support a more assertive clinical decision. Similar to the importance of serum lactate in the management of sepsis, we aim to find a biomarker that can be easily obtained even in the most remote clinical laboratories in remote areas of Brazil and in other Latin American countries Currently, there are no laboratory biomarkers available to support clinical decision-making when differentiating between severe and non-severe patients with PCM, and that, consequently, culminates in the prescription of oral antifungal drugs orally for non-severe patients at the time of admission, or intravenous medication, associated with other hospital support care, for critically ill patients.…”

Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

“…26 According to the literature, NLR is accepted as a parameter that reflects the negative effects of a high number of neutrophils that indicates an acute inflammatory response and the effects of a low number of lymphocytes that indicates the general deterioration of health together with physiological stress. 27,28 Regarding infections, NLR has also been reported as a predictor of severity and clinical outcome in patients with leprosy reactions, 29 community pneumonia 23 or bacteremia. 30 In the literature, NLR has been studied in various inflammatory conditions and neoplastic diseases, ulcerative colitis, Crohn's disease, acute pancreatitis, colorectal cancer, breast cancer, lung cancer and hepatocellular carcinoma.…”