Neutrophil to lymphocyte ratio

In medicine neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. It is calculated by dividing the number of neutrophils by number of lymphocytes, usually from peripheral blood sample,[1] but sometimes also from cells that infiltrate tissue, such as tumor.[2] Recently Lymphocyte Monocyte ratio (LMR) has also been studied as a marker of inflammation including Tuberculosis and various cancers.


Prognosis of cardiovascular diseases[]

Higher NLR is independent predictor of mortality in patients undergoing angiography or cardiac revascularization.[1]

Prognostic marker in cancer[]

Increased NLR is associated with poor prognosis of various cancers,[4] such as esophageal cancer [2] or advanced pancreatic cancer.[5]

Prognostic value in COVID-19[]

Increased NLR in the early stages is associated with worse outcome.[6][7]

Reference values[]

In a recent study, 95% of healthy adult subjects had a ratio between 0.78 and 3.53.[8] 95% range : 2.5% of healthy adults having less than 0.78, and 2.5% above 3.53.[8]


Neutrophil to Lymphocyte ratio was first demonstrated as useful parameter after a correlation of a relationship between the neutrophil lymphocyte ratio to reactions of the immune response was noted. A study in 2001 was conducted by the Department of Anaesthesiology and Intensive Care Medicine, St. Elizabeth Cancer Institute in Bratislava by Zahorec which suggested the routine used of the ratio as a stress factor in clinical ICU practice in intervals of 6-12 and 24 hours.[9]

The first study to demonstrate that pretherapuetic NLR can be used as a predictor of chemotherapy sensitivity to thoracic esophageal cancer was demonstrated by Hiroshi Sato, Yasuhiro Tsubosa, and Tatsuyuki Kawano in a 2012 study published in World Journal of Surgery journal.[10]

Notes and references[]

  1. ^ a b Wang X (Mar 2014). "Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization : A meta-analysis of observational studies". Atherosclerosis. 234 (1): 206–13. doi:10.1016/j.atherosclerosis.2014.03.003. PMID 24681815.
  2. ^ a b Wang J (Jan 2014). "The clinical significance of tumor-infiltrating neutrophils and neutrophil-to-CD8+lymphocyte ratio in patients with resectable esophageal squamous cell carcinoma". J. Transl. Med. 12: 7. doi:10.1186/1479-5876-12-7. PMC 3895663. PMID 24397835.
  3. ^ Hoffman, Lisa (2020-03-31). "BREAKING NEWS: UPDATE ON EVALUATION AND MANAGEMENT FOR COVID-19 PATIENTS--Updated 4/2/20". Emergency Medicine News.
  4. ^ Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, Tannock IF, Amir E (2014). "Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis". J. Natl. Cancer Inst. 106 (6): dju124. doi:10.1093/jnci/dju124. PMID 24875653.
  5. ^ Xue P (Apr 2014). "Neutrophil-to-lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients". Cancer Med. 3 (2): 406–15. doi:10.1002/cam4.204. PMC 3987090. PMID 24519894.
  6. ^ Liu, Jingyuan; Liu, Yao; Xiang, Pan; Pu, Lin; Xiong, Haofeng; Li, Chuansheng; Zhang, Ming; Tan, Jianbo; Xu, Yanli; Song, Rui; Song, Meihua (2020-02-12). "Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage". medRxiv: 2020.02.10.20021584. doi:10.1101/2020.02.10.20021584.
  7. ^ Hoffman, Lisa (2020-03-31). "BREAKING NEWS: UPDATE ON EVALUATION AND MANAGEMENT FOR COVID-19 PATIENTS--Updated 4/2/20". Emergency Medicine News.
  8. ^ a b Forget, Patrice (2017). "What is the normal value of the neutrophil-to-lymphocyte ratio?". BMC Research Notes. 10 (1): 12. doi:10.1186/s13104-016-2335-5. PMC 5217256. PMID 28057051.
  9. ^ Zahorec, R. (2001). "Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill". Bratislavske Lekarske Listy. Bratisl Lek Listy. 102 (1): 5–14. PMID 11723675.
  10. ^ Sato, Hiroshi; Tsubosa, Yasuhiro; Kawano, Tatsuyuki (March 2012). "Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer". World Journal of Surgery. 36 (3): 617–622. doi:10.1007/s00268-011-1411-1. PMID 22223293.

Further reading[]