The neutrophil-to-lymphocyte ratio (NLR) is a simple inflammation score: your neutrophil count divided by your lymphocyte count, both already on a standard blood count. In healthy working-age adults, normal results fell between 0.78 and 3.53. In US adults, a higher NLR was linked to higher death rates.
This article is part of our series on [how to test for inflammation](/articles/how-to-test-for-inflammation).
The numbers
Most people never notice it. A complete blood count, or CBC, is one of the most common blood tests there is, and its white cell section lists neutrophils and lymphocytes. Divide one by the other and you have your NLR. Researchers read it as the balance between body-wide inflammation and the immune system.
| Number | What it means | Source |
|---|---|---|
| 0.78 to 3.53 | Normal NLR range in 413 healthy working adults aged 21 to 66 | |
| 1.65 | The average NLR in that same group | |
| 2.15 | The average NLR in 9,427 US adults in a national health survey, 2007 to 2010 | |
| 1.76 vs 2.24 | Average NLR in non-Hispanic Black adults vs non-Hispanic white adults in that survey | |
| 404,272 | Healthy Chinese adults used to set NLR ranges by age and sex | |
| 1.14 | Hazard ratio for death per step up in NLR quarter, US adults over 30 | |
| 4.38 | The average NLR across 18,231 people with heart failure |
A hazard ratio compares how often something happens in two groups. In the US study, people were split into four equal groups by NLR. Each step up was linked to a 1.14 times higher death rate, or about 14% more.
How to calculate NLR from a blood test
Find two lines on your CBC report: the absolute neutrophil count and the absolute lymphocyte count. They are usually listed in thousands of cells per microliter. Then divide.
No single cutoff has been agreed on. NLR is a flag, not a diagnosis.From a 2022 review in Int J Mol Sci
Here is a worked example using the average counts from the US survey: 4.3 for neutrophils and 2.1 for lymphocytes. This is our arithmetic, not the study's.
4.3 ÷ 2.1 = 2.05
That NLR of about 2 sits well inside the healthy range of 0.78 to 3.53. The survey's own average NLR was 2.15, a little higher. The small gap is normal math: averaging 9,427 separate ratios does not give quite the same answer as dividing two averages.
Only see percentages? Divide those instead. Both are shares of the same white cell total, so the ratio comes out the same.
What is a normal NLR?
For healthy adults who are not elderly, one study put the normal range at 0.78 to 3.53. A second group of healthy volunteers landed in the same range, whichever lab machine ran the test.
Normal also shifts with who you are. In the US survey, Black and Hispanic adults had lower average NLRs than white adults, and the authors suggested cutoffs may need to differ by race. In a study of 404,272 healthy Chinese adults, men had a higher NLR than women. The upper limit of normal rose with age in men.
So the same result can be ordinary for one person and high for another. That is one reason a precise cutoff has not been found.
What moves the number
Infection and acute illness. NLR tracks with death rates in sepsis, pneumonia and COVID-19, and it has been used in decisions about admitting people with COVID-19 pneumonia.
Smoking, diabetes and heart disease. People who reported any of these had a higher NLR.
Metabolic syndrome. That is a cluster of risks like a large waist, high blood sugar and high blood pressure. Across 26 studies of 70,937 people, NLR ran 0.40 higher in people who had it. By our math, that is about a fifth of the US average of 2.15. People with a high NLR were also more likely to develop the syndrome.
Blood pressure. In 21 studies, people with high blood pressure had an NLR 0.40 higher than people without it.
Medicines. The US survey left out people taking steroids, chemotherapy, immune-changing drugs or antibiotics. Tell your provider about every medicine you take before you read much into your result.
Exercise, maybe. In one small randomized trial of people with multiple sclerosis in a rehab clinic, only high-intensity interval training (HIIT) lowered NLR over 3 weeks. Steady, moderate exercise did not. One trial in one illness is a clue, not proof.
When a number should worry you
When it sits above your lab's range for no clear reason. In healthy adults, results above 3.53 fell outside the normal range. One high result is a flag. It is not a diagnosis.
When you have heart failure. The average NLR across 36 heart failure studies was 4.38. People in the top third had 2.49 times the death rate of those in the bottom third.
When you have lung disease. In the US study, the link between NLR and death from chronic lung disease was stronger in people who already had a lung condition.
When you are being treated for cancer. A review of 204 meta-analyses found that a higher NLR went with worse cancer outcomes in all but one of them. Just 60 (29%) reached strong or highly suggestive evidence. The authors said more research is needed before NLR is used to guide care. In the US study, NLR was linked to cancer death only in the first year of follow-up.
What to do with your number
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your NLR is above your lab's range and you have a fever or feel unwell; you have heart failure, lung disease or cancer; you take steroids, chemotherapy, immune-changing medicines or antibiotics (keep taking them as prescribed); or you are pregnant.
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How this article was made
Researched and written from 10 peer-reviewed papers. Our automated check matched every claim against the exact words of its source, confirmed every paper exists in PubMed, and found none retracted. Checked November 6, 2026. Not individually reviewed by a doctor. Photos are illustrative; the people in them are not patients or readers.
Grades run Strong, Moderate, Emerging, Early and Not supported, and the grade decides the words we may use. How we grade evidence · Medical disclaimer
Sources
- StudyWhat is the normal value of the neutrophil-to-lymphocyte ratio?Forget P, Khalifa C, Defour JP et al. BMC Res Notes, 2017.PubMedFull paper
- Cross-sectionalAverage values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects.Azab B, Camacho-Rivera M, Taioli E PLoS One, 2014.PubMedFull paper
- StudyDistribution and reference interval establishment of neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in Chinese healthy adults.Wang J, Zhang F, Jiang F et al. J Clin Lab Anal, 2021.PubMedFull paper
- CohortNeutrophil-to-lymphocyte ratio and mortality in the United States general population.Song M, Graubard BI, Rabkin CS et al. Sci Rep, 2021.PubMedFull paper
- ReviewNeutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases.Buonacera A, Stancanelli B, Colaci M et al. Int J Mol Sci, 2022.PubMedFull paper
- Meta-analysisPredictive role of neutrophil-to-lymphocyte ratio in metabolic syndrome: Meta-analysis of 70,937 individuals.Qiu Z, Huang C, Xu C et al. BMC Endocr Disord, 2024.PubMedFull paper
- Meta-analysisMeta-analysis of differences in neutrophil to lymphocyte ratio between hypertensive and non-hypertensive individuals.Sarejloo S, Dehesh M, Fathi M et al. BMC Cardiovasc Disord, 2023.PubMedFull paper
- Umbrella reviewNeutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies.Cupp MA, Cariolou M, Tzoulaki I et al. BMC Med, 2020.PubMedFull paper
- Meta-analysisNeutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis.Vakhshoori M, Nemati S, Sabouhi S et al. BMC Cardiovasc Disord, 2023.PubMedFull paper
- Randomized trialHigh-intensity interval training reduces neutrophil-to-lymphocyte ratio in persons with multiple sclerosis during inpatient rehabilitation.Joisten N, Proschinger S, Rademacher A et al. Mult Scler, 2021.PubMedFull paper
