Abstract
Evaluating the Role of Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio as Prognostic Markers for Leprosy Disease Activity: A Pre-Post Control Study in Makassar, South Sulawesi
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Background: Neutrophils, lymphocytes, and monocytes are inflammatory cells that play a pivotal role in the pathogenesis of bacterial infections. Numerous studies have utilized the ratio of these three inflammatory cells to predict a range of inflammatory diseases, including leprosy. Nevertheless, research on patient response to anti-leprosy therapy using these hematologic parameters remains scarce.
Aims: To analyze the Neutrophil Lymphocytes Ratio (NLR) and Monocyte Lymphocytes Ratio (MLR) on anti-leprosy treatment response.
Methods: The study employed an observational design and a pre-post control group. The study involved 40 new patients with uncomplicated multibacillary leprosy at the time of release from treatment (RFT). Baseline hematological data was obtained from medical records, and follow-up blood tests were performed 2-3 weeks after completing treatment.
Results: The sample was divided into three categories: 18 subjects with leprosy without reaction, seven with reversal reaction, and 15 with ENL reaction. All samples showed significant differences in NLR and MLR before and after anti-leprosy therapy. The Therapeutic Neutrophil-to-Lymphocyte Ratio Index (Therapeutic NLR Index) values were highest in patients without reaction (81%), followed by those with ENL (79%) and RR (73%). Therapeutic Monocyte-to-Lymphocyte Ratio Index (Therapeutic MLR Index) values were highest in leprosy with ENL (79%), followed by those without reaction (72%) and RR leprosy (71%). The analysis of NLR and MLR using the ROC curve yielded cut-off values of 0.1 and 0.2, respectively, and AUC values of 0.93 and 0.02. The sensitivity and specificity values were 79% and 73%.
Elevated NLR and MLR levels before treatment indicate heightened inflammatory activity in leprosy patients. A decrease in these ratios after therapy suggests improved inflammatory conditions, highlighting the effectiveness of anti-leprosy treatment in reducing inflammation.
Limitations: This study only assesses hematologic changes related to treatment response at the end of the treatment period. Further research is necessary at the 3, 6, or 9-month marks of therapy. A larger sample size and more complex research methods could provide more accurate results.
Conclusion: NLR and MLR can be valuable inflammatory markers to assess disease activity and treatment response in leprosy patients.
Keywords: Leprosy, Hematologic data, Anti-leprosy treatment, Hematologic data
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