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Elevated NLR is an independent prognostic biomarker for Covid-19 patients;implications for CML patients


Hi All,

I am prompted to post this topic following discussion and various debates on what might constitute a healthy immune system in order to protect ourselves in general and also specifically as CML patients that might be at greater risk from Covid -19 infections.

The measure of NLR has made an appearance in the medical literature in recent times especially as an issue that might make us prone to more severe effects of Covid 19 should we be exposed to the virus.

NLR is expressed as a ratio of neutrophils to lymphocytes;N is divided by R. The range for neutrophils is 2.0 -7.5 and the range for lymphocytes is 1.5 -4.0. Normal NLR values  as a ratio in an adult non geriatric population is from 0.78 to 3.53;certain cancers will lead to somewhat higher values than normal and I guess it is a measure of inflammation.Ideally we should have an NLR between 1 and 3.

As CML patients we all have our bloods analysed at regular intervals and potentially have access to monitor our specific blood scores and so be able to estimate our NLR situations.No doubt if we have the misfortune to have excessively low neutrophils and so suffer from neutropenia we will be offered advice on treatment modification/cessation  and how to follow a neutropenia diet and how to safeguard against common infections. In respect of trying to develop a healthy lymphocyte score what I have gleaned from  sources online  is that much of this is related to lifestyle ,diet and exercise;balanced stress levels etc.

I have come across several sources in terms of recent  papers largely the results of research from Chinese authors  and I quote from conclusions that indicate :

"Patients aged greater than 50 and having an NLR greater than 3.13 are predicted to develop critical illness and therefore should have rapid access to an intensive care unit if necessary"

"In the clinical practice of treating patients with Covid 19 we have observed that the NLR of severe patients is higher than in mild patients"

"Elevated age and NLR can be considered independent biomarkers for indicating poor clinical outcomes"

Many of us have been converted to accept the importance of Vitamin D levels in combating infection even though governments and medical authorities still seem to be wary of coming to firm conclusions.

In respect of the of NLR levels and infection might the message be look after your lymphocytes?

Are there any thoughts ?



No harm - indeed quite the reverse - in doing things which should keep your immunity healthy.  I do my best I hope. However, I’m not convinced one should read too much into these papers - especially any absolute numbers reported - without a contextual review of the literature, assessing the data set sizes, variate analyses etc.  I’d want to look at all of that before drawing any conclusions especially with non peer reviewed papers.

I can see that NLR - especially if a result of high neutrophils - is consistent with inflammation problems that are now known in some COVID patients with severe disease (high neutrophils are an indicator of inflammation) and inflammation overload was identified as a problem quite early on in the UK and elsewhere. I don’t think it’s a coincidence that most of the treatments reported in the press as having success are anti inflammatory.   As I understand it, perhaps the most significant progress in treating “severe” COVID is in dealing with inflammatory overload.  

At the moment in any case I’ve just battened down the hatches in our latest lockdown as far as I can, and am looking forward to being jabbed - which we are “promised” will be by the middle of February....