ArticlePloS one2026
The neutrophil-to-lymphocyte ratio as a predictor of all-cause mortality in individuals with anemia: A population-based study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study investigates the association between the neutrophil-to-lymphocyte ratio (NLR) and all-cause mortality in individuals with anemia using the National Health and Nutrition Examination Survey (NHANES) 1999-2018 dataset.
methodsWe included 3,212 participants with anemia, categorized into three groups by NLR values. Baseline characteristics, comorbidities, and demographics were analyzed. We performed univariate logistic regression, multivariable Cox regression, non-linear regression, and breakpoint analysis to examine NLR-mortality relationships. Subgroup analysis assessed effect modification by clinical factors.
resultsThe mean age of the cohort was 56.0 ± 18.3 years. Participants in the highest NLR tertile (T3) had significantly higher mortality risk, with an HR of 1.25 (95% CI:1.07-1.48, p = 0.007) in the fully adjusted model. Univariate logistic regression showed that NLR was independently associated with mortality (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.35-1.52, p < 0.001), with higher mortality risk in the highest NLR tertile (OR = 2.9, 95% CI: 2.39-3.53, p < 0.001). Multivariable Cox regression analysis confirmed NLR as a significant predictor (hazard ratio [HR] = 1.11, 95% CI: 1.07-1.15, p < 0.001). A non-linear regression analysis identified a data-derived threshold at NLR = 1.475, with the risk of mortality increasing significantly above this threshold (HR = 1.134, 95% CI: 1.073-1.2, p < 0.001).
conclusionNLR is a significant predictor of all-cause mortality in individuals with anemia. Elevated NLR, particularly above 1.475, is associated with a 25.0% higher mortality risk, suggesting its potential utility as a prognostic biomarker in this context.
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