Diagnostic value of the neutrophil lymphocyte ratio in discrimination between tuberculosis and bacterial community acquired pneumonia: A meta-analysis

Background: We conducted a systematic review and meta-analysis, based on Preferred Reporting Items for Sys-tematic Reviews and Meta-analyses (PRISMA) guidelines, to evaluate current literature on diagnostic value of neutrophil to lymphocyte ratio (NLR) in discrimination between tuberculosis (TB) and bacterial community acquired pneumonia (B-CAP).Methods: Literature search was conducted from July 20, 2023 using Scopus, PubMed, and Web of Science databases. STATA software (version 12.0; Stata Corporation) was used for all analyses.Results: We found that patients with TB had significantly lower levels of NLR compared to those with B-CAP (SMD =-1.09, 95 %CI = -1.78--0.40,P = 0.002). In the quality subgroup analysis, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP consistent in moderate (SMD =-0.86, 95 %CI =-2.30, 0.57, P = 0.23) and high-quality studies (SMD =-1.25, 95 %CI =-2.07,-0.42). In the subgroup analysis based on continent, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP in studies performed in Asian populations (SMD =-1.37, 95 %CI =-2.13,-0.61, P < 0.001), but not on African population (SMD =-0.02, 95 %CI =-1.06, 1.02, P = 0.97). The result of this study did not change after execution of sensitivity analysis. The pooled sensitivity of NLR was 0.86 (95% CI = 0.80, 0.91), and the pooled specificity was0.88 (95% CI = 0.69, 0.95).Conclusion: Patients with TB had a significantly lower NLR levels compared to those with B-CAP, so we utilized this biomarker for distinguishing between the disorders.