Biomarkers · Inflammation
Neutrophil-to-Lymphocyte Ratio (NLR)
Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 22% higher risk of death. We found the same pattern in NHANES
NLR and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death from our NHANES fit, relative to its reference value. The dotted vertical line marks the NHANES median.
NLR by age and sex
Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.
The percentiles as a table
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 0.89 | 1.36 | 1.79 | 2.34 | 3.53 | 1,456 | NHANES 2017-2018 |
| All | 40-59 | 0.97 | 1.43 | 1.87 | 2.51 | 3.85 | 1,582 | NHANES 2017-2018 |
| All | 60+ | 1.04 | 1.55 | 2.12 | 2.92 | 4.44 | 1,939 | NHANES 2017-2018 |
| All | all | 0.96 | 1.44 | 1.89 | 2.56 | 4.00 | 4,977 | NHANES 2017-2018 |
| Men | 20-39 | 0.85 | 1.29 | 1.72 | 2.28 | 3.77 | 698 | NHANES 2017-2018 |
| Men | 40-59 | 1.04 | 1.42 | 1.90 | 2.61 | 4.04 | 740 | NHANES 2017-2018 |
| Men | 60+ | 1.02 | 1.57 | 2.25 | 3.06 | 4.69 | 981 | NHANES 2017-2018 |
| Men | all | 0.95 | 1.41 | 1.88 | 2.60 | 4.09 | 2,419 | NHANES 2017-2018 |
| Women | 20-39 | 0.95 | 1.46 | 1.88 | 2.40 | 3.49 | 758 | NHANES 2017-2018 |
| Women | 40-59 | 0.94 | 1.43 | 1.84 | 2.47 | 3.53 | 842 | NHANES 2017-2018 |
| Women | 60+ | 1.04 | 1.53 | 2.05 | 2.79 | 4.33 | 958 | NHANES 2017-2018 |
| Women | all | 0.96 | 1.48 | 1.90 | 2.52 | 3.92 | 2,558 | NHANES 2017-2018 |
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in NLR, study by study
1 effect with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| behavioral | Mindfulness-based stress reduction training (prenatal mindfulness RCT) | Third-trimester NLR significantly lower with prenatal mindfulness training vs usual care (F = 7.11, p = 0.019; small pilot) | RCT | Unger KG, et al. The Impact of Mindfulness Treatment on Maternal Inflammation… |
| exercise | Supervised combined endurance and resistance exercise | 12-week combined aerobic + resistance program lowered NLR vs standard care at 24 weeks (p <0.001; effect size not reported) | RCT | Harihar A, et al. Effects of an exercise-based program on neutrophil-lymphocyte… |
| exercise | Regular (chronic) exercise training and cardiovascular conditioning | Chronic exercise lowered NLR (MD -0.30, 95% CI -0.56 to -0.04; k = 15); acute exercise transiently raises NLR 1-3 h after | meta-analysis | Khanzade S, et al. Change in neutrophil-to-lymphocyte ratio after acute and… |
| nutraceutical | Anti-inflammatory botanical extract (highly bioavailable curcumin) | Bioavailable curcumin for 4 wk significantly reduced NLR in elderly (p=0.020); no change with placebo | RCT | Kishimoto A, et al. Newly Developed Highly Bioavailable Curcumin Formulation… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Severe Sepsis, Acute Bacterial Infection, or Critical Care Shock | Severe sepsis/septic shock: neutrophils 94% and lymphocytes 3.8% of WBC vs 62.5% and 28.1% before scheduled surgery | prospective cohort | Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter… |
| sleep | Chronic psychological distress and sleep disturbance | Higher NLR associated with psychological distress (K6) and insomnia (AIS) scores in 62,796 adults (p<0.0001) | cross-sectional | Akaishi T, et al. Low Hemoglobin Level and Elevated Inflammatory Hematological… |
What else moves this marker
They describe those study groups, not an individual, and an association is not a cause.
Diseases and conditions
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↑ Alzheimer's disease · AD patients vs healthy controls | +0.59 ratio (95% CI 0.38 to 0.8) | AD (mean NLR 2.68) vs healthy controls (mean NLR 2.06) · 12 studies; 1309 AD patients, 1929 MCI, 2064 healthy controls | meta analysis · PMID 38917167 |
| ↑ Ankylosing spondylitis · AS patients vs healthy controls | SMD +0.418 (95% CI 0.239 to 0.598) | AS vs healthy controls · 10 studies; 765 AS patients, 701 healthy controls | meta analysis · PMID 30605008 |
| ↑ Mild cognitive impairment · MCI vs healthy controls | +0.37 ratio (95% CI 0.22 to 0.52) | MCI (mean NLR 2.42) vs healthy controls (mean NLR 2.06) · 12 studies; 1929 MCI, 2064 healthy controls | meta analysis · PMID 38917167 |
| ↑ Parkinson's disease · PD patients vs healthy individuals | SMD +0.81 (95% CI 0.47 to 1.14) | PD vs healthy controls · Studies comparing NLR in PD vs healthy individuals (search to June 2023) | meta analysis · PMID 37735638 |
| ↑ Polycystic ovary syndrome · PCOS women vs healthy women | SMD +0.81 (95% CI 0.3 to 1.33) | PCOS vs healthy controls · 13 studies; 826 PCOS patients, 780 healthy controls | meta analysis · PMID 36197242 |
| ↑ Stroke with early neurological deterioration · stroke patients with END vs stroke patients without END | SMD +0.73 (95% CI 0.42 to 1.05) | END vs no END among stroke patients · 9 studies of stroke patients | meta analysis · PMID 36033552 |
Sources
- Fest J, Ruiter TR, Groot Koerkamp B, Rizopoulos D, Ikram MA, van Eijck CHJ, et al. The neutrophil-to-lymphocyte ratio is associated with mortality in the general population: The Rotterdam Study. Eur J Epidemiol. 2019;34(5):463-470.
- NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Neutrophil-to-Lymphocyte Ratio (NLR) against another biomarker.
Related markers: Alpha-1-Antichymotrypsin (AACT) · Alpha-1-Antitrypsin (AAT) · Antinuclear Antibodies (ANA) · CD4:CD8 T-Cell Ratio · CD8+ T-Cell Count · Erythrocyte Sedimentation Rate (ESR) · Fibrinogen · Growth Differentiation Factor-15 (GDF-15)