The monocyte-to-lymphocyte ratio: Sex-specific differences in the tuberculosis disease spectrum, diagnostic indices and defining normal ranges Article Swipe
Thomas S. Buttle
,
Claire Y. Hummerstone
,
Thippeswamy Billahalli
,
Richard J. Ward
,
Korina E. Barnes
,
Natalie J. Marshall
,
Viktoria C. Spong
,
Graham Bothamley
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0247745
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0247745
Background The monocyte-to-lymphocyte ratio (MLR) has been advocated as a biomarker in tuberculosis. Our objective was to evaluate its clinical value and associations. Methods Blood counts, inflammatory markers and clinical parameters were measured in patients with and those screened for tuberculosis. Complete blood counts (CBCs) from a multi-ethnic population aged 16 to 65 years were evaluated; a sub-group with normal hematological indices was used to define the range of MLRs. Results Multivariate analysis in proven tuberculosis (n = 264) indicated MLR associated with low serum albumin, high white cell counts and a positive culture; values were higher in sputum smear-positive pulmonary tuberculosis (S+PTB). Analysis in S+PTB (n = 296) showed higher MLRs in males and those with high neutrophil counts, low serum albumin and high C-reactive protein. The diagnostic value of MLRs was assessed by comparing notified patients with TB (n = 264) with denotified cases (n = 50), active case-finding in non-contacts (TB n = 111 and LTBI n = 373) and contacts of S+PTB (n = 149) with S+PTB found at screening (n = 75). Sensitivities and specificities ranged from 58.0–62.5% and 50.0–70.0% respectively for optimal cut-off values, defined by ROC curves. In CBCs obtained over one month, ratios correlated with neutrophil counts (ρ = 0.48, P<0.00001, n = 14,573; MLR = 0.45 at 8–8.9 x 10 9 /L) and were higher in males than females (P<0.0001). The MLR range (mean ± 2SD) in those with normal hematological indices (n = 3921: females 0.122–0.474; males 0.136–0.505) paralleled LTBI MLRs. Ratios did not predict death (n = 29) nor response to treatment (n = 178 S+PTB with follow-up CBCs). Ratios were higher in males than female in the 16–45 years age group, where immune differences due to sex hormones are likely greatest. Conclusions Severe tuberculosis and male sex associated with high MLRs; the same variables likely affect the performance of other biomarkers. The ratio performed poorly as a clinical aid.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0247745
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247745&type=printable
- OA Status
- gold
- Cited By
- 24
- References
- 48
- Related Works
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- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3197003180Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1371/journal.pone.0247745Digital Object Identifier
- Title
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The monocyte-to-lymphocyte ratio: Sex-specific differences in the tuberculosis disease spectrum, diagnostic indices and defining normal rangesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2021Year of publication
- Publication date
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2021-08-30Full publication date if available
- Authors
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Thomas S. Buttle, Claire Y. Hummerstone, Thippeswamy Billahalli, Richard J. Ward, Korina E. Barnes, Natalie J. Marshall, Viktoria C. Spong, Graham BothamleyList of authors in order
- Landing page
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https://doi.org/10.1371/journal.pone.0247745Publisher landing page
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247745&type=printableDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
- OA URL
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0247745&type=printableDirect OA link when available
- Concepts
-
Tuberculosis, Medicine, Internal medicine, Gastroenterology, Sputum, Lymphocyte, Immunology, Population, White blood cell, Neutrophil to lymphocyte ratio, Pathology, Environmental healthTop concepts (fields/topics) attached by OpenAlex
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24Total citation count in OpenAlex
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2025: 7, 2024: 3, 2023: 8, 2022: 5, 2021: 1Per-year citation counts (last 5 years)
- References (count)
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48Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.years | 53, 280 |
| abstract_inverted_index.(CBCs) | 44 |
| abstract_inverted_index.CBCs). | 269 |
| abstract_inverted_index.Ratios | 251, 270 |
| abstract_inverted_index.Severe | 294 |
| abstract_inverted_index.active | 149 |
| abstract_inverted_index.affect | 307 |
| abstract_inverted_index.counts | 43, 89, 204 |
| abstract_inverted_index.define | 65 |
| abstract_inverted_index.female | 276 |
| abstract_inverted_index.group, | 282 |
| abstract_inverted_index.higher | 96, 110, 223, 272 |
| abstract_inverted_index.immune | 284 |
| abstract_inverted_index.likely | 291, 306 |
| abstract_inverted_index.month, | 199 |
| abstract_inverted_index.normal | 59, 238 |
| abstract_inverted_index.poorly | 316 |
| abstract_inverted_index.proven | 74 |
| abstract_inverted_index.ranged | 180 |
| abstract_inverted_index.ratios | 200 |
| abstract_inverted_index.showed | 109 |
| abstract_inverted_index.sputum | 98 |
| abstract_inverted_index.values | 94 |
| abstract_inverted_index.14,573; | 211 |
| abstract_inverted_index.16–45 | 279 |
| abstract_inverted_index.8–8.9 | 216 |
| abstract_inverted_index.Methods | 23 |
| abstract_inverted_index.Results | 70 |
| abstract_inverted_index.albumin | 122 |
| abstract_inverted_index.counts, | 25, 119 |
| abstract_inverted_index.curves. | 193 |
| abstract_inverted_index.cut-off | 188 |
| abstract_inverted_index.defined | 190 |
| abstract_inverted_index.females | 227, 244 |
| abstract_inverted_index.indices | 61, 240 |
| abstract_inverted_index.markers | 27 |
| abstract_inverted_index.optimal | 187 |
| abstract_inverted_index.predict | 254 |
| abstract_inverted_index.values, | 189 |
| abstract_inverted_index.(S+PTB). | 102 |
| abstract_inverted_index.Analysis | 103 |
| abstract_inverted_index.Complete | 41 |
| abstract_inverted_index.albumin, | 85 |
| abstract_inverted_index.analysis | 72 |
| abstract_inverted_index.assessed | 133 |
| abstract_inverted_index.clinical | 19, 29, 319 |
| abstract_inverted_index.contacts | 163 |
| abstract_inverted_index.culture; | 93 |
| abstract_inverted_index.evaluate | 17 |
| abstract_inverted_index.hormones | 289 |
| abstract_inverted_index.measured | 32 |
| abstract_inverted_index.notified | 136 |
| abstract_inverted_index.obtained | 196 |
| abstract_inverted_index.patients | 34, 137 |
| abstract_inverted_index.positive | 92 |
| abstract_inverted_index.protein. | 126 |
| abstract_inverted_index.response | 260 |
| abstract_inverted_index.screened | 38 |
| abstract_inverted_index.advocated | 7 |
| abstract_inverted_index.biomarker | 10 |
| abstract_inverted_index.comparing | 135 |
| abstract_inverted_index.follow-up | 268 |
| abstract_inverted_index.greatest. | 292 |
| abstract_inverted_index.indicated | 79 |
| abstract_inverted_index.objective | 14 |
| abstract_inverted_index.performed | 315 |
| abstract_inverted_index.pulmonary | 100 |
| abstract_inverted_index.screening | 173 |
| abstract_inverted_index.sub-group | 57 |
| abstract_inverted_index.treatment | 262 |
| abstract_inverted_index.variables | 305 |
| abstract_inverted_index.Background | 0 |
| abstract_inverted_index.C-reactive | 125 |
| abstract_inverted_index.associated | 81, 299 |
| abstract_inverted_index.correlated | 201 |
| abstract_inverted_index.denotified | 144 |
| abstract_inverted_index.diagnostic | 128 |
| abstract_inverted_index.evaluated; | 55 |
| abstract_inverted_index.neutrophil | 118, 203 |
| abstract_inverted_index.paralleled | 248 |
| abstract_inverted_index.parameters | 30 |
| abstract_inverted_index.population | 48 |
| abstract_inverted_index.Conclusions | 293 |
| abstract_inverted_index.biomarkers. | 312 |
| abstract_inverted_index.differences | 285 |
| abstract_inverted_index.performance | 309 |
| abstract_inverted_index.50.0–70.0% | 184 |
| abstract_inverted_index.58.0–62.5% | 182 |
| abstract_inverted_index.Multivariate | 71 |
| abstract_inverted_index.case-finding | 150 |
| abstract_inverted_index.inflammatory | 26 |
| abstract_inverted_index.multi-ethnic | 47 |
| abstract_inverted_index.non-contacts | 152 |
| abstract_inverted_index.respectively | 185 |
| abstract_inverted_index.tuberculosis | 75, 101, 295 |
| abstract_inverted_index.P<0.00001, | 208 |
| abstract_inverted_index.Sensitivities | 177 |
| abstract_inverted_index.associations. | 22 |
| abstract_inverted_index.hematological | 60, 239 |
| abstract_inverted_index.specificities | 179 |
| abstract_inverted_index.tuberculosis. | 12, 40 |
| abstract_inverted_index.(P<0.0001). | 228 |
| abstract_inverted_index.0.122–0.474; | 245 |
| abstract_inverted_index.0.136–0.505) | 247 |
| abstract_inverted_index.smear-positive | 99 |
| abstract_inverted_index.monocyte-to-lymphocyte | 2 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5028069486, https://openalex.org/A5015094936, https://openalex.org/A5073034940, https://openalex.org/A5080667432, https://openalex.org/A5047827336, https://openalex.org/A5090548311, https://openalex.org/A5067091980, https://openalex.org/A5018219528 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 8 |
| corresponding_institution_ids | https://openalex.org/I166337079, https://openalex.org/I4210089966, https://openalex.org/I4210098291 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8299999833106995 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.81711443 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |