What is Neutrophil / Lymphocyte Ratio?
Neutrophil-to-lymphocyte ratio (NLR) is calculated by dividing the absolute neutrophil count by the absolute lymphocyte count.
- Neutrophils are your immune system’s first responders to pathogens and infections. They are a part of the innate immune system, which reacts quickly during acute stress, inflammation, or infection.
- Lymphocytes are specialized white blood cells that identify specific pathogens such as viruses and bacteria. They destroy infected cells and create immune memory, allowing the body to recognize and respond more quickly to future infections.
The NLR is an inflammation marker that reflects the balance between these two cell types. When neutrophils increase and lymphocytes decrease, the ratio rises, typically reflecting acute stress, inflammation, or immune dysregulation.
Why Does Neutrophil / Lymphocyte Ratio Matter?
NLR provides insight into several aspects of health:
- Immune system balance: The ratio reflects the relationship between innate immune activity (neutrophils) and adaptive immune function (lymphocytes).
- Systemic inflammation: Elevated NLR correlates with chronic low-grade inflammation associated with aging, sometimes called “inflammaging.”
- Physiological stress: Both psychological stress and physical stress can shift immune cell populations, raising NLR.
- Disease progression and prognosis: NLR has been studied as a prognostic marker in several conditions, including cardiovascular disease, sepsis, cancer, and autoimmune disorders.
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How to Interpret NLR
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of a Healthy Neutrophil / Lymphocyte Ratio
- Keeping NLR within a healthy range is associated with:
- Lower systemic inflammation
- Reduced cardiovascular disease risk
- Improved immune regulation
- Better metabolic health1
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Low NLR Levels
Low NLR typically indicates a well-balanced immune system and is associated with a longer life, lower risk of frailty, and a reduced risk of cardiovascular disease and Alzheimer’s disease.2, 3, 4
However, very low or rapidly falling NLR values can occasionally reflect immune suppression, viral infections, or bone marrow disorders.
High NLR Levels
A high NLR can stem from chronic stress, poor sleep, obesity, infection, or an underlying condition like metabolic syndrome or cardiovascular disease. Symptoms come from whatever condition is driving the inflammation or infection.
Symptoms:
- Persistent fatigue
- Unexplained weight loss
- Poor wound healing
- Fever
- Chills
- Malaise
- Joint pain
Causes:
- Systemic inflammation
- Physical stress
- Bacterial infections
- Cardiovascular disease
- Obesity
- Extreme overtraining
Healthspan Impacts:
How Hone Treats Out of Range Neutrophil to Lymphocyte Ratio
Your Hone physician will evaluate NLR alongside your other lab values, symptoms, and overall health. Because NLR is calculated from a complete blood count (CBC), they will review NLR alongside related markers that signal inflammation to understand the underlying cause and develop a personal treatment plan.
- Antibiotics* – to treat bacterial infections
- Corticosteroids* – to reduce inflammation
- Biologics/Targeted therapies* – to treat specific conditions like rheumatoid arthritis
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Quit smoking
- Adopt a Mediterranean-style diet that is rich in healthy fats, vegetables and fruit, and nuts and seeds.
- Limit alcohol consumption
- Get at least 7-8 hours of sleep per night9
Qiu, Z., et al. (2024). Predictive role of neutrophil-to-lymphocyte ratio in metabolic syndrome: Meta-analysis of 70,937 individuals. BMC Endocrine Disorders.
↑Lagunas-Rangel, F. A. (2025). Neutrophil-to-lymphocyte ratio in aging: Trends and clinical implications. Experimental Gerontology.
↑Chmielewski, P. P., et al. (2025). Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker for Long-Term Survival in Older Adults at a Mental Health Care Center: A Historical Cohort Analysis. Journal of Clinical Medicine.
↑Song, S., et al. (2024). Neutrophil-to-lymphocyte ratio as a predictor of all-cause and cardiovascular mortality in coronary heart disease and hypertensive patients: A retrospective cohort study. Frontiers in Endocrinology.
↑Larsen, M. K., et al. (2024). Neutrophil-to-lymphocyte ratio and all-cause mortality with and without myeloproliferative neoplasms—A Danish longitudinal study. Blood Cancer Journal.
↑Buonacera, A., et al. (2022). Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. International Journal of Molecular Sciences.
↑McBurney, M. I., Tintle, N. L., & Harris, W. S. (2022). Omega-3 index is directly associated with a healthy red blood cell distribution width. Prostaglandins, Leukotrienes and Essential Fatty Acids
↑Tabatabaeizadeh, S. A., et al. (2017). High Dose Supplementation of Vitamin D Affects Measures of Systemic Inflammation: Reductions in High Sensitivity C-Reactive Protein Level and Neutrophil to Lymphocyte Ratio (NLR) Distribution. Journal of cellular biochemistry.
↑Fang, S., et al. (2016). Associations between sleep quality and inflammatory markers in patients with schizophrenia. Psychiatry Research.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
