Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update
Abstract
As we know, inflammatory and oxidative stresses have a role in the pathogenesis of cardiovascular disease. This knowledge has triggered many investigations targeted to inflammatory markers. One such example, the neutrophil to lymphocyte ratio (NLR), is an inexpensive and easily accessible inflammatory marker whose role in cardiovascular disease has been studied extensively in the past few years. The neutrophil lymphocyte ratio has been shown to predict cardiac arrhythmias as well as short- and long-term mortality in patients with acute coronary syndromes (ACS). It has correlated well with ACS risk prediction models such as the GRACE and SYNTAX scores. A higher NLR has also been associated with frequent congestive heart failure decompensation and long-term mortality. The neutrophil to lymphocyte ratio also appears to have a prognostic role in patients undergoing transaortic valve replacement and the progression of valvular heart diseases. Despite the science of inflammatory biomarkers having been described decades ago, NLR appears to be enjoying a renaissance as a cost-effective biomarker with immediate clinical predictability and prognostication.
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NLR, PLR, and MLR are tests that can be easily measured using a complete blood count and can be used as markers of inflammatory processes in diseases such as autoimmune diseases.
“Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are tests that can be easily measured using a complete blood count, can be used as markers of inflammatory processes in diseases such as autoimmune diseases, and have been shown to be prognostic indicators.3,4”
From Association Between Mood Disorder Severity, Treatment Response and Systemic Inflammatory Markers: Exploring the Role of NLR, PLR, MLR, and SII (2024) · cites this paper as [3]
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“Several researchers have proven that these ratios have the value to be used as biomarkers of poor prognosis or major inflammation among patients with chronic medical conditions such as cardiovascular diseases (Afari and Bhat, 2016; Li et al., 2017b), malignancies (Li et al.”
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“Neutrophil‐lymphocyte ratio (NLR), which neutrophils counts are divided by lymphocyte counts, is used as a new additional inflammatory markers [7].”
MethodDynamic changes in routine blood parameters of a severe COVID-19 case
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“19,20 Neutrophils secrete in fl ammatory mediators that can cause vascular wall degeneration.”
BackgroundContaldi, E., Magistrelli, L., Cosentino, M., Marino, F., & Comi, C. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195543 · Cited by 33 · see citing works
Özkan, U., Gürdoğan, M., Öztürk, C., Demir, M., Akkuş, Ö., Yilmaz, E., & Altay, S. (2022) · Medicina · doi:10.3390/medicina58020143 · Cited by 29
“The SII represents three important immune response paths: inflammation that is reflected by neutrophilia, thrombosis that is reflected by platelets, and the body’s stress response, reflected by low lymphocyte [14,15].”
BackgroundXu, Y., Fang, H.-Y., Qiu, Z.-Q., & Cheng, X.-S. (2020) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-020-01263-3 · Cited by 29
Berillo, O., Huo, K.-G., Fraulob-Aquino, J. C., Richer, C., Briet, M. B., Boutouyrie, P., Lipman, M. L., Sinnett, D., Paradis, P., & Schiffrin, E. L. (2020) · American Journal of Hypertension · doi:10.1093/ajh/hpaa031 · Cited by 31 · see citing works
Nieters, A., Blagitko‐Dorfs, N., Peter, H., & Weber, S. (2019) · SLEEP · doi:10.1093/sleep/zsz098 · Cited by 30 · see citing works
Woziwodzka, K., Dziewierz, A., Pawica, M., Panek, A., Krzanowski, M., Gołasa, P., Latacz, P., Burkat, M., Kuz'niewski, M., & Krzanowska, K. (2019) · Folia medica Cracoviensia · doi:10.24425/fmc.2019.131380 · Cited by 29
“[24] NLR as a marker of CV diseases has a greater predictability than total white blood cell (WBC) count or neutrophil count.”
BackgroundSheng, J.-L., Liu, N., He, F., Cheng, C., Shen, S., & Sun, Y. (2021) · Clinics · doi:10.6061/clinics/2021/e2580 · Cited by 28
“The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been increasingly and extensively applied as inflammatory indicators in inflammation-related disease research because they are easy to use and are obtained using inexpensive tests (9,13-18).”
MethodNeutrophil-lymphocyte ratio as a marker for disability and activity in multiple sclerosis.
Fahmi, R., Ramadan, B. M., Salah, H., Elsaid, A. F., & Shehta, N. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.102921 · Cited by 28
Haj-Yehia, E., Mincu, R., Korste, S., Lampe, L., Margraf, S. M., Michel, L., Mahabadi, A., Ferdinandy, P., Rassaf, T., & Totzeck, M. (2023) · Clinical Research in Cardiology · doi:10.1007/s00392-023-02327-9 · Cited by 26 · see citing works
“In patients with acute coronary syndrome, NLR showed predictive capacity for myocardial damage and cardiac dysfunction as well as arrhythmia [46, 47].”
BackgroundYılmaz, B., Somay, E., Selek, U., & Topkan, E. (2021) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s334556 · Cited by 26 · see citing works
Wu, S., Yang, Y., Zhu, J., Ren, J., Wang, J., Zhang, H., & Shao, X. (2021) · Angiology · doi:10.1177/00033197211000495 · Cited by 29 · see citing works
“The NLR has emerged as a significant prognostic indicator of cardiovascular (CV) diseases, including stable coronary artery disease, acute coronary syndrome, and heart failure.(6) In the setting of AF, elevated NLR has been reported to be independently associated with an increased risk of new-onset AF after coronary a…”
BackgroundShi, M., Yang, C., Tang, Q.-W., Xiao, L.-F., Chen, Z.-H., & Zhao, W.-Y. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.745560 · Cited by 25
Estella, Á., García-Garmendia, J., de la Fuente, C., Casas, J. F. M., Yuste, M., Villar, R. A., Estecha, M., Mateos, L., Bulnes, M. C., Loza, A., et al. (2021) · Medicina Intensiva · doi:10.1016/j.medine.2021.02.008 · Cited by 25 · see citing works
Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures
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“Elevated NLR levels have been reported in disease states such as cardiovascular disease (Afari and Bhat 2016) and autoimmune diseases such as rheumatoid arthritis (Mercan et al. 2016).”
BackgroundPerioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes
Giakoumidakis, K., Fotos, N., Patelarou, A., Theologou, S., Argiriou, M., Chatziefstratiou, A. A., Katzilieri, C., & Brokalaki, H. (2017) · Pragmatic and Observational Research · doi:10.2147/por.s130560 · Cited by 25
Neutrophil-Lymphocyte Ratio in Predicting Infective Endocarditis: A Case-Control Retrospective Study
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Factors affecting the mortality of February earthquakes victims in Türkiye.
Dişel, N. R., Taskin, O., Daglioglu, G., Tor, B., Seçinti, S., Devecioglu, G. F., & Taskin, A. A. E. (2023) · American Journal of Emergency Medicine · doi:10.1016/j.ajem.2023.12.017 · Cited by 23
Verheyen, V., Remy, S., Govarts, E., Colles, A., Martin, L. R., Koppen, G., Voorspoels, S., Bruckers, L., Bijnens, E., Vos, S., et al. (2021) · Toxics · doi:10.3390/toxics9100245 · Cited by 23 · see citing works
“The combined neutrophil–lymphocyte ratio (NLR) is a clinically used inflammatory biomarker that correlates well with increased severity of infections, respiratory and cardiovascular diseases [40,41] that may provide information on relevant immunologic changes.”
BackgroundAssociations Between Subclinical Inflammatory Markers and OCD: A Retrospective Study
Herdi, O., Akaslan, D. S., İlhan, R. S., Çolak, B., & Duman, B. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113065 · Cited by 24 · see citing works
- Authors
- Afari, M. E., & Bhat, T.
- Affiliations
- Tufts University (US)
- Corresponding author
- Bhat, Tariq
- ORCID
- Afari, Maxwell E.
- Venue
- Expert Review of Cardiovascular Therapy
- Publisher
- Informa UK Limited
- Published
- 2016-03-04
- Volume
- 14
- Issue
- 5
- Pages
- 573-577
- ISSN
- 1477-9072 (ISSN-L)
- 1744-8344
- OpenAlex
- W2285799691
- Cited by
- 439
- References
- 0
- Citations by year
- 2026: 31 · 2025: 48 · 2024: 55 · 2023: 63 · 2022: 72 · 2021: 63 · 2020: 46 · 2019: 26 · 2018: 19 · 2017: 10 · 2016: 6
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Cardiovascular Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- neutrophil-to-lymphocyte ratio, inflammatory markers, cardiovascular disease, acute coronary syndrome, cardiac arrhythmias, mortality prediction, congestive heart failure, aortic valve replacement, valvular heart disease, oxidative stress, GRACE risk score, SYNTAX score
- MeSH terms
- Cardiovascular Diseases, Heart Failure, Humans, Lymphocytes, Neutrophils, Prognosis, Risk, Biomarkers, Disease Progression, Acute Coronary Syndrome
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