Abstract
Active Mycobacterium tuberculosis infection heavily disrupts blood rheology and oxygenation. While routine testing focuses on leukocyte spikes, a critical clinical gap remains regarding how systemic inflammation drives tissue hypoxia. This study evaluates how age, biological sex, and migration status modulate erythrocyte sedimentation rate (ESR) and peripheral oxygen saturation (SpO2) in native Libyan and migrant cohorts in Tripoli, Libya. Retrospective metadata from 100 active tuberculosis cases at Abu-Setta Hospital were analyzed, balanced between native Libyans (n = 50) and migrants (n = 50). Cellular profiles, demographic tiers, housing conditions, and homeostatic metrics were cross-stratified and evaluated using comparative and correlation statistical frameworks. The cohort exhibited a stark generational divide (P < 0.001), with migrants being younger (32.10 ± 11.42 years) and Libyans older (47.32 ± 19.27 years). Socio-environmental tracking revealed that the history of incarceration was significantly higher among the mobile migrant group (14.0% vs. 2.0%, P = 0.005). Biologically, a distinct presence of systemic hypertension was found segregated exclusively within the native Libyan subgroup (10.0% of Libyans, P = 0.028, representing 5.0% of the entire cohort). Conversely, erythroid suppression induced a moderate, sex-dimorphic presentation of functional anemia; migrant females sustained the lowest overall hemoglobin nadir (9.10 g/dL), followed closely by native Libyan females (9.60 g/dL). Crucially, bivariate correlation isolated a significant physiological association between systemic acute-phase kinetics and peripheral oxygenation (P = 0.026); accelerated erythrocyte sedimentation was directly coupled with a progressive downshift in peripheral oxygenation, establishing a decline in SpO2 as a dynamic, non-invasive reflection of microvascular rheological stress under chronic active infection. In conclusion, active tuberculosis in Tripoli drives distinct demographic and physiological phenotypes. While older native hosts present with prolonged hyper-inflammatory metrics, female and migrant sub-cohorts exhibit the highest hematological vulnerability. Crucially, the isolated ESR-SpO₂ coupling demonstrates that non-invasive bedside pulse oximetry can serve as a practical, low-cost prognostic tracker of microvascular stress and homeostatic decline within resource-limited clinical networks.