Xiaoshan He, Yuting Jiang, Hongbiao Hou, Wentao Wu

Department of Infectious Diseases, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China

Correspondence: Xiaoshan He, Department of Infectious Diseases, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China, Email hxshan1999@163.com

Objective: This study aimed to investigate whether pretreatment hematological parameters and clinical features are associated with diabetes mellitus (DM) in patients with pulmonary tuberculosis (PTB).
Methods: A retrospective study was conducted at Meizhou People’s Hospital from April 2016 to December 2020, including 1106 PTB patients— 326 PTB-DM patients as the case group and 780 non-DM PTB patients as the control group. The clinical manifestations were collected, and the level of the inflammation index was measured. Receiver operating characteristic (ROC) curves were used to assess the diagnosis and analysis of the selected indices.
Results: There were no significant differences in the clinical manifestations including gender and age distribution, fever, shortness of breath/difficulty in breathing, expectoration, and extrapulmonary tuberculosis (all p> 0.05). The level of ESR was higher, while the levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), system immune inflammation index (SII), and system inflammation response index (SIRI) were lower in PTB-DM patients than those in non-DM PTB patients (all p< 0.05). Regression analysis showed that erythrocyte sedimentation rate (ESR) (p< 0.001), MLR (p=0.021), and PLR (p=0.003) were found as the independent risk factors for DM in PTB patients. The area under ROC curve (AUC) value of ESR was 0.619 (95% CI: 0.590– 0.648, cut-off value: 45.5), MLR was 0.600 (95% CI 0.570– 0.629, cut-off value: 0.765), PLR was 0.584 (95% CI: 0.554– 0.613, cut-off value: 239.615), ESR+MLR was 0.689 (95% CI: 0.661– 0.716), ESR+PLR was 0.694 (95% CI: 0.666– 0.721), MLR+PLR was 0.610 (95% CI: 0.574– 0.645), and ESR+MLR+PLR was 0.712 (95% CI 0.685– 0.739), respectively.
Conclusion: ESR, MLR, and PLR are associated with the risk of DM in patients with PTB. In particular, the combined detection of ESR, MLR, and PLR showed higher sensitivity and specificity for the diagnosis of DM among patients with PTB.

Keywords: pulmonary tuberculosis, diabetes mellitus, inflammatory markers, ESR, MLR, PLR