Association Between Neutrophil-Lymphocyte Ratio and All-Cause Mortality and Cause-Specific Mortality in US Adults, 1999–2014

Abstract

Background Neutrophil-lymphocyte ratio (NLR) is a novel marker of inflammation. Emerging studies have evaluated the relationship of NLR with cardiovascular diseases and malignant conditions. However, rare studies regarded the association between NLR and long-term health status. This study aimed to evaluate the association of NLR with all-cause mortality and cause-specific mortality among adults in the United States. Methods We obtained eight cycles data of National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2014, and enrolled 32328 participants after certain screening. By weighted chi-square test and linear regression analysis, we analyzed the correlation between NLR and baseline characteristics of the participants. Kaplan–Meier curves and Cox regression models were used to assess the survival relevance of NLR. We conducted stratified analysis, interaction analysis, and sensitivity analysis to robustness of our results. Results Participants with high NLR levels had a higher risk of death. After adjustment for baseline characteristics, the hazard ratio comparing the higher vs lower NLR levels was 1.43 (95% CI, 1.18–1.73) for all-cause mortality, 1.27 (95% CI, 0.84–1.92) for cancer mortality, and 1.44 (95% CI, 0.96–2.16) for cardiovascular disease mortality. Stratified analysis found that the observed associations between NLR levels and mortality did not differ significantly. Conclusion In this nationally representative cohort of US adults, higher NLR was significantly associated with an increased risk of all-cause mortality.

A meta-analysis of immune-cell fractions at high resolution reveals novel associations with common phenotypes and health outcomes

“…This is consistent with a recent cell count study in type 2 diabetes [118] and a study demonstrating an increased neutrophil-to-lymphocyte ratio (NLR) in COPD [119]. An increased NLR has also been recently associated with an increased all-cause mortality [120], with HRs similar to those reported here. Considering individual health outcomes was important: for instance, while the memory B-cell fraction did not correlate with all-cause mortality, an increase in this fraction was associated with an increased risk of cancer and simultaneously with a reduced risk of T2D.…”

Prognostic Value of the Neutrophil-to-lymphocyte Ratio, Platelet-to- lymphocyte Ratio and Monocyte-to-lymphocyte Ratio in Melanoma Patients: A Cohort Study

“…Second, we have included all clinical stages of melanoma, and there was a balanced proportion between stages. Third, we used MSS as the primary endpoint instead of OS because an elevated NLR is associated with increased all-cause mortality in the general population ( 40 ). Lastly, the cut-off values for NLR, PLR and MLR in our study were determined by using maximally selected rank statistics, which is believed to be a more appropriate method than ROC analysis, which was used in the majority of previous studies ( 33 ).…”

Prognostic Value of Neutrophil-to-lymphocyte Ratio for Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea

“…The NLR is increasingly being used as a biomarker for managing various inflammation-associated diseases, such as CVD, cancer, and autoimmune diseases [33][34][35][36]. Kim et al [37] and Sunbul et al [21] have shown that the NLR can be used to predict OSA and its severity.…”