Comparison of Neutrophil-to-Monocyte-Plus-Lymphocyte Ratio and Systemic Immune-Inflammation Index Between Pulmonary Tuberculosis and Community-Acquired Pneumonia Patients

Introduction: Pulmonary tuberculosis (PTB) and community-acquired pneumonia (CAP) are significant global health challenges with overlapping clinical manifestations, which often complicates rapid diagnosis in resource-limited settings.This study evaluates the potential of the neutrophil-to-monocyte-pluslymphocyte ratio (NMLR) and the systemic immune-inflammation index (SII) as affordable and accessible hematological markers to help differentiate between these two respiratory infections.Methods: A retrospective, cross-sectional observational study was conducted at Ngoerah Hospital, Denpasar, Indonesia, using medical record data from January 2022 to September 2025.The subjects included 25 PTB patients and 24 CAP patients who met the eligibility criteria.Median values of NMLR and SII were compared using the Mann-Whitney U test.Results: CAP patients were generally older (mean age 61.0 years) and had a higher male prevalence (75%) compared to PTB patients (mean age 47.4 years; 44% male).All CAP patients (100%) presented with comorbidities, while TB patients showed a lower prevalence of 64%.Although the CAP group exhibited higher median values for NMLR (3.26 vs. 2.63; p=0.082) and SII (1335.77vs. 1241.45;p=0.280), these differences did not reach statistical significance.Conclusion: No significant differences were found in NMLR and SII values between PTB and CAP patients in the study.This suggests that a high burden of chronic comorbidities, such as heart failure and chronic kidney disease, may mask specific host immune responses to acute and chronic infections.This study stresses the limitations of single inflammatory indices in populations with multiple comorbidities, emphasizing that further investigation into multiparametric diagnostic models is vital for enhancing management precision.