The association of neutrophil-to-lymphocyte ratio with bronchiectasis severity assessed by the FACED classification in adults with post-tuberculosis bronchiectasis

The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple, cost-effective biomarker of systemic inflammation in various respiratory diseases. However, its association with bronchiectasis severity in patients with post-tuberculosis bronchiectasis remains limited. This study aimed to investigate the association between NLR and bronchiectasis severity as assessed by the FACED classification and to identify factors contributing to disease severity in patients with post-tuberculosis bronchiectasis. This retrospective cross-sectional study involved 49 patients with post-tuberculosis bronchiectasis. Bronchiectasis severity was assessed using the FACED score. NLR was calculated from routine complete blood counts. The Mann-Whitney U test compared NLR between mild and moderate severity groups, and factors associated with moderate severity were also analyzed. The median NLR was significantly higher in patients with moderate bronchiectasis compared to those with mild disease (7.16 vs. 3.25, p=0.043), driven primarily by significantly lower lymphocyte percentage in the moderate group (11.20 vs. 22.05, p=0.043). Moderate severity was significantly associated with forced expiratory volume in 1 second <50% predicted (p<0.001), radiological extension involving more than two lobes (p=0.010), and a modified Medical Research Council dyspnea score ≥2 (p=0.049). No significant associations were observed for age, sex, comorbidities, smoking status, or Pseudomonas colonization. Taken together, NLR is significantly elevated in patients with moderate bronchiectasis compared to those with mild disease, primarily reflecting relative reduced lymphocyte percentage in more severe disease. As an easily obtainable, inexpensive biomarker, NLR may serve as a practical tool for initial risk stratification in post-tuberculosis bronchiectasis, particularly in resource-limited settings.