# The neutrophil-to-lymphocyte ratio as a predictor of all-cause mortality in individuals with anemia: A population-based study

## TL;DR

This study finds that a higher neutrophil-to-lymphocyte ratio is linked to increased risk of death in people with anemia.

## Contribution

The study identifies a specific NLR threshold (1.475) as a significant predictor of mortality in anemic individuals.

## Key findings

- Participants in the highest NLR tertile had a 25% higher mortality risk.
- A threshold NLR of 1.475 was found to significantly increase mortality risk.
- NLR was independently associated with mortality in multiple regression models.

## Abstract

This 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.

We 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.

The 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).

NLR 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.