Neutrophil-to-Lymphocyte Ratio and Mortality in Cardiovascular Disease or Cancer: A Population-Based Cohort Study

Inflammation contributes to development and progression of cardiovascular disease (CVD) and cancer. Whether the neutrophil-to-lymphocyte ratio (NLR), routinely available from blood counts, predicts prognosis in the general population is uncertain.

The purpose of this study was to evaluate the association of NLR with mortality in people with and without CVD or cancer.

In this retrospective cohort study, we used National Health Service records from the Greater Glasgow & Clyde region for people aged >50 years in 2012. Participants were classified hierarchically into 5 exclusive groups: history of cancer, heart failure (HF, or dispensed loop diuretics), CVD, CV risk factors only, or none. Mortality was tracked until December 2019.

We identified 223,388 people with NLR measured between 2014 and 2015: 106,973 (48%) with CV risk factors only, 14,490 (7%) with CVD, 23,009 (10%) with HF or dispensed loop diuretics, 8,677 (4%) with cancer, and 70,239 (31%) none of these features. Median NLR was lowest in the latter group (2.0 [1.5-2.7]) and highest in those with HF or dispensed loop diuretics (2.7 [1.9-3.9]) or cancer (2.7 [1.9-4.1]). Median follow-up was 5.0 years (IQR: 4.4-5.0). In models adjusted for age, sex, estimated glomerular filtration rate, and hemoglobin, the highest NLR quartile predicted higher mortality across all groups (HR [95% CI] 2.07 [1.98-2.17] for CV risk factors and 2.18 [2.02-2.36] for none; 1.87 [1.70-2.04] for CVD, 2.10 [1.98-2.24] for HF or loop diuretics, and 2.30 [2.10-2.52] for cancer).

Higher NLR is associated with greater mortality in adults with and without CVD, HF or cancer, suggesting it could enhance population risk scores.