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. 2021 Sep;35(9):e23935.
doi: 10.1002/jcla.23935. Epub 2021 Aug 13.

Distribution and reference interval establishment of neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in Chinese healthy adults

Junjun Wang  1 , Fan Zhang  1 , Feng Jiang  1 , Lijuan Hu  1 , Jian Chen  1 , Yumin Wang  1
Affiliations

Distribution and reference interval establishment of neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in Chinese healthy adults

Junjun Wang et al. J Clin Lab Anal. 2021 Sep.

Abstract

Background: Neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are associated with coronavirus disease 2019 (COVID-19) and many diseases, but there are few data about the reference interval (RI) of NLR, LMR, and PLR.

Methods: The neutrophil count, lymphocyte count, monocyte count, and platelet count of 404,272 Chinese healthy adults (>18 years old) were measured by Sysmex XE-2100 automatic hematology analyzer, and NLR, LMR, and PLR were calculated. According to CLSI C28-A3, the nonparametric 95% percentile interval is defined as the reference interval.

Results: The results of Mann-Whitney U test showed that NLR (p < .001) in male was significantly higher than that in female; LMR (p < .001) and PLR (p < .001) in male were significantly lower than that in female. Kruskal-Wallis H test showed that there were significant differences in NLR, LMR, and PLR among different genders and age groups (p < .001). The linear graph showed that the reference upper limit of NLR and PLR increased with age and the reference upper limit of LMR decreases with age in male population. In female population, the reference upper limit of NLR in 50-59 group, LMR in >80 group, and PLR in 70-79 group appeared a trough; the reference upper limit of NLR in >80 group, LMR in 50-59 group, and PLR in 40-49 group appeared peak.

Conclusion: The establishment of RI for NLR, LMR, and PLR in Chinese healthy adults according to gender and age will promote the standardization of clinical application.

Keywords: lymphocyte-to-monocyte ratio; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; reference interval.

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Figures

FIGURE 1
FIGURE 1
Establishing reference interval of neutrophil‐to‐lymphocyte ratio, lymphocyte‐to‐monocyte ratio, and platelet‐to‐lymphocyte ratio on the bias of Clinical and Laboratory Standards Institute CA28‐A3
FIGURE 2
FIGURE 2
Distribution histogram of three indicators. A, Kolmogorov‐Smirnov test showed that NLR data showed skewed distribution. B, Kolmogorov‐Smirnov test showed that LMR data showed skewed distribution. C, Kolmogorov‐Smirnov test showed that PLR data showed skewed distribution
FIGURE 3
FIGURE 3
Values of upper reference limits for three indicators in different age partitions. A, The reference upper limit of NLR increased with age in male population. In female population, the reference upper limit of NLR in 50–59 group showed a trough and the reference upper limit of NLR in >80 group showed peak. B, The reference upper limit of LMR decreases with age in male population. In female population, the reference upper limit of LMR in >80 group showed a trough and the reference upper limit of LMR in 50–59 group showed peak. C, The reference upper limit of PLR increased with age in male population. In female population, the reference upper limit of PLR in 70–79 group showed a trough and the reference upper limit of PLR in 40–49 group showed peak
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