The treasure trove of blood chemistry… Neutrophil Lymphocyte Ratio (NLR)
By Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN
Blood carries everything from nutrients and oxygen, to clues that help practitioners solve the puzzle of disease and dysfunction. This is where functional blood chemistry analysis can help more fully evaluate a patient’s condition.
Using a readily available CBC with differentiation report, a practitioner can assess the neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammation associated with more severe disease and complications.
In general, a higher NLR correlates with poor prognosis and higher mortality rates, even when white blood cell count is normal. Elevated NLR is associated with an increased probability of bacterial infection and lower probability of viral infection.
Neutrophils and lymphocytes participate in cell-mediated inflammatory responses and an increased NLR is associated with elevated inflammatory markers including tumor necrosis factor alpha, IL-6, IL7, IL-8, IL-12, and IL-17. 
Accumulating research suggests an association between an elevated NLR and worse outcomes for several cancers including breast, ovarian, gastroesophageal, pancreas, colon, colorectal, hepatocellular, biliary tract, kidney, and urothelium.   An elevated NLR also appears to reflect more aggressive disease associated with advanced tumor stage and metastases and reduced overall survival  
Increased ratio of neutrophils to lymphocytes is also observed in congestive heart failure, atherosclerotic changes, cardiovascular disease, diabetes mellitus, hypertension, severe acute pancreatitis, sepsis, and septic shock.     
Clinicians should investigate NLR values of greater than 2.2 in order to identify the potential significance of neutrophil lymphocyte ratios in their patients. A detailed account of a patient’s medical history and current symptomatology, along with further blood chemistry analysis, will help bring a patient’s full clinical picture into focus.
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