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Peer-reviewedCC BYClinics and practice

Age and Sex Influence the Neutrophil-to-Lymphocyte Ratio (NLR), a Systemic Inflammation Marker.

  • Carmen Lara-Apolinario1,2
  • Cesar Martinez-Carral2,3
  • Desiree Fischetti4
  • Adexe J Fulgencio-González4
  • Casimira Domínguez4
  • Pedro C Lara2,5,6
6 affiliations
  1. 1Preventive Medicine and Public Health Department, Infanta Elena University Hospital, 28342 Madrid, Spain.
  2. 2Medicine Department, Fernando Pessoa Canarias University, 35450 Guía, Spain.
  3. 3Preventive Medicine and Public Health Department, Cruces University Hospital, 48903 Barakaldo, Spain.
  4. 4Laboratory Medicine Department, Dr Negrín University Hospital, 35010 Las Palmas de Gran Canaria, Spain.
  5. 5Canarian Comprehensive Cancer Center, San Roque University Hospital, 35001 Las Palmas de Gran Canaria, Spain.
  6. 6Canarian Institute of Cancer Research, 38320 La Laguna, Spain.
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Abstract

Background/Objectives: The neutrophil-to-lymphocyte ratio (NLR), as a marker of systemic inflammation, has been studied in a wide variety of diseases. Unfortunately, there are very limited data describing the NLR distribution and reference intervals for a normal population in specific geographical areas. The aim of this study was to analyze, for the first time, different patterns in NLR distribution, stratified by age and sex, in a large group of controls from a European country. Methods: Patients referred for a health examination to the Laboratory Department of Dr Negrín University Hospital from 1 January 2021 to 31 December 2025 were included in this study. The participants had normal hematological values, lipid metabolism markers and hepatic enzymes, erythrocyte sedimentation rates (ESRs), and C-reactive protein (CRP) levels. Samples were treated anonymously, including only sex and date of birth. The neutrophil-to-lymphocyte ratio (NLR) was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. Results: A total of 30,676 controls were included in the study. NLR increased with age (p < 0.0001). Women showed lower NLR values than men (p < 0.0001), revealing an age-related pattern, with values increasing until age 45, dropping from 46 to 65, and slightly increasing in advanced age (>65 years). Conclusions: To our knowledge, this is the largest study from a European country analyzing the impact of sex and age on NLR values in controls. An interesting differential pattern of NLR modifications according to age group was observed in women. Therefore, NLR values must always be interpreted according to sex and age groups.

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Cite

BibTeXRIS
BibTeX
@article{laraapolinario2026influence,
  title = {{Age and Sex Influence the Neutrophil-to-Lymphocyte Ratio (NLR), a Systemic Inflammation Marker.}},
  author = {Carmen Lara-Apolinario and Cesar Martinez-Carral and Desiree Fischetti and Adexe J Fulgencio-González and Casimira Domínguez and Pedro C Lara},
  journal = {Clinics and practice},
  year = {2026},
  month = sep,
  doi = {10.3390/clinpract16100178},
  url = {https://europepmc.org/article/MED/42930364},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Age and Sex Influence the Neutrophil-to-Lymphocyte Ratio (NLR), a Systemic Inflammation Marker.
AU  - Carmen Lara-Apolinario
AU  - Cesar Martinez-Carral
AU  - Desiree Fischetti
AU  - Adexe J Fulgencio-González
AU  - Casimira Domínguez
AU  - Pedro C Lara
PY  - 2026
DA  - 2026/09/24
JO  - Clinics and practice
DO  - 10.3390/clinpract16100178
UR  - https://europepmc.org/article/MED/42930364
AB  - Background/Objectives: The neutrophil-to-lymphocyte ratio (NLR), as a marker of systemic inflammation, has been studied in a wide variety of diseases. Unfortunately, there are very limited data describing the NLR distribution and reference intervals for a normal population in specific geographical areas. The aim of this study was to analyze, for the first time, different patterns in NLR distribution, stratified by age and sex, in a large group of controls from a European country. Methods: Patients referred for a health examination to the Laboratory Department of Dr Negrín University Hospital from 1 January 2021 to 31 December 2025 were included in this study. The participants had normal hematological values, lipid metabolism markers and hepatic enzymes, erythrocyte sedimentation rates (ESRs), and C-reactive protein (CRP) levels. Samples were treated anonymously, including only sex and date of birth. The neutrophil-to-lymphocyte ratio (NLR) was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. Results: A total of 30,676 controls were included in the study. NLR increased with age (p < 0.0001). Women showed lower NLR values than men (p < 0.0001), revealing an age-related pattern, with values increasing until age 45, dropping from 46 to 65, and slightly increasing in advanced age (>65 years). Conclusions: To our knowledge, this is the largest study from a European country analyzing the impact of sex and age on NLR values in controls. An interesting differential pattern of NLR modifications according to age group was observed in women. Therefore, NLR values must always be interpreted according to sex and age groups.
SN  - 2039-7275
SN  - 2039-7283
ER  -