Cited by 439Inflammatory Biomarkers in Disease PrognosisInflammation biomarkers and pathwaysSepsis Diagnosis and Treatment

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Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update

Afari, Maxwell E., Bhat, Tariq·2016·Expert Review of Cardiovascular Therapy

DOI 10.1586/14779072.2016.1154788

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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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Cardiovascular involvement in Behçet’s disease patients: Carotid atherosclerosis, neutrophil–lymphocyte ratio, platelet-lymphocyte ratio, and serum asymmetric dimethylarginine
Sayed, O., Abdel-Magied, R., Farrag, H. M. A., Elela, M. A. A., Safwat, A., & Abdel-Nasser, A. (2025) · Egyptian Rheumatologist · doi:10.1016/j.ejr.2025.07.004
Preoperative peripheral blood routine indicators as predictors of prognosis and diagnosis in glioma under the 2021 World Health Organization classification
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The Association between Neutrophil-to-lymphocyte Ratio and Live Birth Rate among Women Diagnosed with Recurrent Pregnancy Loss
Zagdon-Keidar, S., Weinstock, T., & Bashiri, A. (2025) · International Journal of Recurrent Pregnancy Loss · doi:10.5005/ijrpl-11032-0006
Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease
Liu, J., Zhou, A., Zheng, M.-D., Wang, L., & Zeng, P. (2025) · Perioperative Medicine · doi:10.1186/s13741-025-00527-7
“In patients with acute coronary syndromes, NLR has been shown to be a predictor of cardiac arrhythmias (Afari and Bhat 2016).”
Biomarcadores hematológicos na detecção de inflamação com doença renal crônica em hemodiálise: uma análise avaliativa
Oliveira, F. S., Morais, M. J. D. D., de Souza, C. S., Pérez-Riera, A. R., & de Abreu, L. C. (2025) · Journal of Human Growth and Development · doi:10.36311/jhgd.v35.16080
Comprehensive mapping of immune perturbations associated with secondary hemophagocytic lymphohistiocytosis
Chen, Y., Deng, H., Zhou, R., Jiang, X., Wang, H., Xin, S., Mo, W., Wang, S., & Liu, Y. (2024) · Journal of Leukocyte Biology · doi:10.1093/jleuko/qiae138 · Cited by 1
Laboratory findings of postoperative venous thromboembolism (VTE) in Dr. Sardjito General Hospital, Yogyakarta
Supomo, Mulyono, B., Sukorini, U., Arjana, A. Z., & Novenanto, T. T. (2024) · Indonesian Journal of Biomedicine and Clinical Sciences · doi:10.22146/inajbcs.v56i2.13627
“18 Otasevic et al .”
Background
Association of inflammatory and hematological indices with left ventricular hypertrophy in hypertensive patients
Павлова, О. С., Ясюкайть, Н. В., Барбук, О. А., Denisevich, T. L., Zataloka, N. V., Ивановна, Р. И., & Kolyadko, M. G. (2024) · Arterial’naya Gipertenziya (Arterial Hypertension) · doi:10.18705/1607-419x-2024-2405 · Cited by 9
Relationship Between Systemic Immune-inflammation Index and Coronary Slow Flow
Duran, M., & Özen, M. (2023) · The Journal of Tepecik Education and Research Hospital · doi:10.4274/terh.galenos.2022.36675
“They also uncovered the adverse effects of these hematological parameters on various cardiovascular conditions (24,25) .”
Using hematological markers to assess the anti-inflammatoryeffects of selected dietary components
Szymańska, P., & Golanski, J. (2023) · Diagnostyka Laboratoryjna · doi:10.5604/01.3001.0016.2829
Correlation Between Coronary Lesion Severity Detected in Fractional Flow Reserve with Systemic Immune Inflammation Index and Atherogenic Plasma Index
Güzel, T., & Kış, M. (2022) · Bagcilar Medical Bulletin · doi:10.4274/bmb.galenos.2022.2022-04-036
“The association of these markers with mortality and adverse clinical outcomes in cardiovascular diseases has been reported (8).”
Prognostic and diagnostic value of the ratio of neutrophils to lymphocytes of patients with diseases of the gastrointestinal tract and liver
Sarkarova, M. R., & Maevskaya, M. V. (2022) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2022-16-7-60-68 · Cited by 6
eyin Apselerinin Tanı ve Farmakolojik Tedavisinde NLO Değeri Önemli midir?
Çalışkan, T., Yilmaz, İ., Hacıoğlu, F., Ersoz, E., Doğan, M., & Karaarslan, N. (2021) · Acta Medica Alanya · doi:10.30565/medalanya.946066
Changes in Routine Blood Tests in COVID-19: A Case at Janaki Medical College
Prakash, S. (2021) · MedS Alliance Journal of Medicine and Medical Sciences · doi:10.3126/mjmms.v1i2.46519
“Furthermore, inflammation and immunological factors enhanced thrombopoietin (TPO), which promoted platelet formation [33, 34].”
Background
ADS Score as a Novel Predictor of Outcomes in Patients Who Underwent Percutaneous Coronary Intervention
Zhang, W.-J., Liu, G.-Q., Shangguan, J.-H., Zhu, X.-D., Wang, W., Guo, Q.-Q., Zhang, J., Wang, K., Liu, Z.-Y., Song, F.-H., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.720597
Diagnostic values of a model based on B-type natriuretic peptide, C reactive protein, and neutrophil-lymphocyte ratio for diagnosis of diabetic heart diseases patients
Omran, M., Taha, Y., Kadry, M., Eltaweel, F., Emran, T., & Tabll, A. (2021) · Journal of Bioscience and Applied Research · doi:10.21608/jbaar.2021.201445
“NLR is easy to obtain, low-cost, commonly available inflammation index, which can help in the prediction of patients with different cardiovascular diseases (Afari and Bhat, 2016).”
Background
Relationship of Neutrophil–Lymphocyte Ratio with coronary artery disease and plaque composition of coronary arteryPreprint
Wang, R., Gu, H., Ji, C., Gao, Y., Gao, L., Qin, S., & Wang, X.-M. (2021) · Research Square · doi:10.21203/rs.3.rs-826088/v1
Correlation between Inflammatory Markers and Liver Enzymes in Patients with Post-Traumatic Stress Disorder
Fajkić, A., Mušanović, J., Lepara, O., Musić, M., Pepić, E., Džubur, A., Džubur, A., & Lisica, D. (2021) · Journal of Evolution of Medical and Dental Sciences · doi:10.14260/jemds/2021/108
A neotype nomogram based on accessible clinical indicators to predict the overall survival of esophageal cancer patients underwent radical resectionPreprint
Li, X., Xu, J., Zhu, L., Yang, S.-J., Yu, L., Lv, W., & Hu, J. (2020) · doi:10.21203/rs.3.rs-87555/v1
“PLR and NLR are not only related to the prognosis of malignant tumors, but also determined in in ammatory diseases such as Rheumatic Disease and cardiovascular diseases.(33, 34) EC is dependent on the complex interaction between the tumor and the hosts’ in ammatory response, so the distinction of PLR and NLR shown bet…”
Background
Identification of immunocompetent cells in tissues by scanning electron microscopy in backscattered electrons
Mukhamadiyarov, R., Milto, I., & Kutikhin, A. (2020) · Arkhiv patologii · doi:10.17116/patol20208204170
Neutrophil-to-lymphocyte Ratio as a Risk Determinant of Hemorrhage Transformation in Acute Ischemic Stroke
Ma, S.-T., Muhammad, B., Kan, S., Shang, Z.-Y., Wang, L., Lv, J., Wang, Z.-P., Wang, W., Chen, X., Mu, Y., et al. (2020) · doi:10.36922/jmn.v5i1.900
“Neutrophil-to-lymphocyte ratio (NLR) is a rather new risk determinant factor of the inflammatory response that has been shown to be associated with the severity and prognosis of cardiovascular events, ischemic stroke, cancer, and bacterial infectious disease [8-11].”
Background
Variability in blood lipid affects the neutrophil to lymphocyte ratio in patients who have undergone elective percutaneous coronary intervention: A retrospective study
Zhao, L.-D., Xu, T., Li, Y., Luan, Y., Lv, Q., Fu, G., & Zhang, W.-B. (2020) · doi:10.21203/rs.2.24079/v1
“3 Atherosclerosis accounts for elevated morbidity and mortality worldwide[3].”
Background
Response to: the neutrophil-lymphocyte ratio and atherosclerosis
Afari, M., & Bhat, T. M. (2016) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2016.1194200
Self-citation
Inflammatory Profiles in Young, UniversityAffiliated Conflict-Affected Adults: Neutrophilto-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Displaced and Non-Displaced Yemeni Adults
Ali, N. T., Mehdi, M. A. H., Abdullah, R. S., Al-Abd, N., & Gubran, A. N. M. (2026) · Yemen Journal of Medicine · doi:10.63475/yjm.v5i1.0348
“[8, 9] Despite the recognized utility of NLR and PLR as inflammatory markers, their application in conflict-affected populations remains unexplored.”
Research Progress on the Association between Neutrophil-to-Lymphocyte Ratio (NLR) and Hypertensive Left Ventricular Hypertrophy
Bao, H.-Y. (2026) · Advances in Clinical Medicine · doi:10.12677/acm.2026.1672694
Índices de inflamación en enfermedad arterial coronaria crónica estable
Salazar, J., Inciarte, D., Briceño, S., Bracho, M., Esis, C., Silva, E., & Añez, R. (2025) · Cardiovascular and Metabolic Science · doi:10.35366/119628
Patterns of Neutrophil to Lymphocyte Ratio Change in two Inflammatory Rheumatic Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis
Mihaliček, A. (2025) · Acta Clinica Croatica · doi:10.20471/acc.2025.64.03.17
“It is considered that an increase in NLR reflects a systemic inflammatory response 1,5 and that it is a good biomarker of systemic inflammation, because it combines two different immune pathways; neutrophils (Ne), which represent nonspecific immunity, and lymphocytes (Ly), which represent specific…”
Predictive Value of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Transcatheter Aortic Valve Replacement
Gao, Z. (2024) · Advances in Clinical Medicine · doi:10.12677/acm.2024.1441130
Correlation of Serum MHR and NLR with SYNTAX Scores in Patients with Unstable An-gina Pectoris of Different Genders
Yang, Y.-P. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.1361370
Recent Advances in Biomarkers of Myocardial Damage in Sepsis
阿卜力提普, ·. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.1392114
Neutrophil/Lymphocyte ratio can distinguish transudate and exudate pericardial effusions
Zencir, C., Çayırlı, S., Gülaştı, S., Türkdoğan, A., Akgüllü, Ç., & Güngör, H. (2021) · The Annals of Clinical and Analytical Medicine · doi:10.4328/acam.20734
Assessment as a Prognostic Marker by Meta-analysis of the Neutrophil/Lymphocyte Ratio in Acute Stroke
Fern, Fuertes-Guiro, O., & Camiran-Blesa, E. (2020) · doi:10.36648/2572-5483.5.1.02
“Based on these findings, many studies have linked the variations of these two cell populations in the prognosis of severity and extent of brain injury during stroke [31,32].”
Background
Value of Platelet/Lymphocyte Ratio as a Predictor of Coronary Artery Disease Severity
Hamoda, A., Ebaid, H., Elrabbat, K., & Elemaary, M. (2020) · SunText Review of Medical & Clinical Research · doi:10.51737/2766-4813.2020.010

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
DOI: 10.1586/14779072.2016.1154788
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 › Critical Care and Intensive Care Medicine › 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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Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update

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