Neutrophil Lymphocyte Ratio (NLR) Calculator

Determines the level of physiological stress based on the ratio of absolute or relative neutrophils to lymphocytes.

Refer to the text below the tool for more information about the parameters involved and the interpretation of the ratio.


Under physiological stress, the number of neutrophils tends to increase whilst the number of lymphocytes decreases. Neutrophil Lymphocyte Ratio is able to quantify in a simple to compute ratio these changes and correlate them to the severity of physiological stress.

NLR can act as a red flag alerting of a dysregulated immune system, whether from inflammation, malignancy or other causes. Its changes, especially in the case of acute physiological stress, can be detected more quickly compared to the changes to the white blood cell count which take longer to reflect the physiological status.


  • NLR = Absolute Neutrophil Count (ANC) / Absolute Lymphocyte Count (ALC)
  • NLR = Relative Neutrophil % / Relative Lymphocyte %
Neutrophil Lymphocyte Ratio Physiological stress level
1 - 3 Normal
4 - 5 -
6 - 8 Mild
9 - 18 Moderate
>18 Severe

Absolute neutrophil count (ANC)
Absolute lymphocyte count (ALC)
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Relative Neutrophil %
Relative Lymphocyte %
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Neutrophil Lymphocyte Ratio Explained

Under physiological stress, the number of neutrophils tends to increase whilst the number of lymphocytes decreases. NLR is able to quantify in a simple to compute ratio these changes and correlate them to the severity of physiological stress.

The mechanism is linked to the action of endogenous cortisol and catecholamines, perhaps also that of cytokines, endogenous catecholamines and other hormones.

Formulas

The correlation between NLR and physiological stress levels

Neutrophil Lymphocyte Ratio Physiological stress level
1 - 3 Normal
4 - 5 -
6 - 8 Mild
9 - 18 Moderate
>18 Severe

NLR can act as a red flag alerting of a dysregulated immune system, whether from inflammation, malignancy or other causes. Critically ill patients will often have an NLR of 9 or higher. NLR tends to increase rapidly following acute physiologic stress (<6 hours).​

In a study by Biyik et al. on patients with liver cirrhosis, it was found that NLR of at least 2.72 had a significantly lower survival.

In a study by Templeton et al. on data from 100 studies (totalling 40,559 cancer patients’ data), a NLR greater than 4 was associated with statistically poorer survival in all disease subgroups, sites, and stages.

Whilst the NLR was found to perform better than standard white blood cell count in determining physiological stress, it has not proven to have any differentiating properties, for example differentiating haemorrhagic shock from septic shock.

Limitations of the NLR include a direct increase if the patient is under exogenous steroid therapy, or if the patient suffers from an active haematological disorder that affects cell count.

 

References

Original Reference

Zahorec R. Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102(1):5-14.

Other references

Biyik M, Ucar R, Solak Y, Gungor G, Polat I, Gaipov A, Cakir OO, Ataseven H, Demir A, Turk S, Polat H. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2013; 25(4):435-41.

Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017; 10(1):12.

Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6):dju124.

Park JM. Neutrophil-to-lymphocyte ratio in trauma patients. J Trauma Acute Care Surg. 2017; 82(1):225-226.


Specialty: Hematology

System: Circulatory

Year Of Study: 2001

Abbreviation: NLR

Article By: Denise Nedea

Published On: June 16, 2020

Last Checked: June 16, 2020

Next Review: June 16, 2025