ALI Calculator – Advanced Lung Cancer Inflammation Index
Enter weight and height (or the BMI directly) and the laboratory values, and choose the units used by your laboratory - the index is calculated automatically.
Result
ALI: —
Interpretation following Jafri et al., 2013: —
How to interpret the ALI
The ALI is a continuous value. Lower values reflect a lower BMI, lower albumin and a higher neutrophil-to-lymphocyte ratio, i.e. more systemic inflammation. In the original study, patients with metastatic non-small cell lung cancer (NSCLC) were divided at an ALI of 18:
| ALI | Group | Patients | Response to chemotherapy | Median PFS | Median OS |
|---|---|---|---|---|---|
| < 18 | High systemic inflammation | 83 | 18% | 2.4 months | 3.4 months |
| ≥ 18 | Low systemic inflammation | 90 | 56% | 5.1 months | 8.3 months |
PFS = progression-free survival, OS = overall survival. Patients with ALI < 18 were also more likely to have more than two metastatic sites (58% vs. 35%), a poor performance status (ECOG 2–4: 32% vs. 17%) and to receive no chemotherapy at all (49% vs. 20%). These data come from patients with newly diagnosed stage IV NSCLC and cannot be transferred directly to other diseases or stages.
What is the ALI?
The advanced lung cancer inflammation index (ALI) combines the body mass index, serum albumin and the neutrophil-to-lymphocyte ratio (NLR) into one index of systemic inflammation. It was developed by Syed H. Jafri and colleagues at Louisiana State University Health, Shreveport (USA), and published in BMC Cancer in 2013.
The retrospective study included 173 patients diagnosed with metastatic (stage IV) NSCLC between January 2000 and June 2011 (median age 57 years, 67% male, 52% adenocarcinoma). Values were taken at or close to the date of diagnosis. For predicting response to treatment, the area under the ROC curve was 0.74 for the ALI, compared with 0.67 for the neutrophil count, 0.61 for the lymphocyte count, 0.65 for albumin and 0.70 for BMI. The optimal cut point was 18.4 (sensitivity 77.3%, specificity 63.9%); for simplicity, the authors divided patients at 18. In multivariate analysis, ALI < 18 was an independent predictor of shorter overall survival (hazard ratio 1.42, 95% CI 1.003–2.01) and progression-free survival (hazard ratio 1.66, 95% CI 1.18–2.33).
Later studies
A meta-analysis of nine studies with 1736 patients found that a low ALI was associated with worse overall survival across cancer types (hazard ratio 1.70, 95% CI 1.41–1.99), with significant results in NSCLC, small cell lung cancer, colorectal cancer, head and neck squamous cell carcinoma and diffuse large B-cell lymphoma. The cut-offs used in these studies ranged from 15.5 to 37.66 (median 23.2) (Hua et al., 2019). A meta-analysis restricted to lung cancer (eight studies, 1587 patients) reported a hazard ratio of 1.64 (95% CI 1.34–1.93) for overall survival and 1.71 (95% CI 1.35–2.07) for progression-free or recurrence-free survival with a low ALI (Zhang and Chen, 2019).
Formula
ALI = BMI [kg/m²] × Albumin [g/dl] / NLR
BMI = weight [kg] / height [m]². If the BMI is already known, it can be entered directly.
NLR = absolute neutrophil count / absolute lymphocyte count. Neutrophils and lymphocytes only enter as a ratio, so any unit can be used as long as it is the same for both.
Example: weight 70 kg and height 175 cm give a BMI of 22.86 kg/m². With albumin 3.8 g/dl, neutrophils 4500/µl and lymphocytes 1500/µl (NLR 3.0), ALI = 22.86 × 3.8 / 3.0 = 29.0.
Limitations
- The index was developed in a retrospective chart review at a single US institution with 173 patients. The authors themselves called for validation in a prospective cohort.
- Since overall mortality during the observation period was very high (97.8%), the cut-off was chosen with response to treatment rather than survival as the outcome of the ROC analysis.
- Height, weight, albumin and blood counts were not necessarily measured on the same day; most were within two weeks of diagnosis.
- The ALI is a continuous variable, so there may be little difference between values of 17 and 19, although they fall on opposite sides of the cut-off.
- Later studies used different cut-offs (15.5 to 37.66), so the value of 18 applies to metastatic NSCLC at diagnosis.
- None of the components is specific: BMI is affected by fluid retention and oedema, albumin by liver disease and fluid status, and the neutrophil-to-lymphocyte ratio by infections, corticosteroids and chemotherapy.
Frequently asked questions
Is a high or a low ALI better?
A high ALI is favourable. In the original study, patients with ALI < 18 (high systemic inflammation) had a median overall survival of 3.4 months, compared with 8.3 months for patients with ALI ≥ 18.
How do I convert units for the ALI?
The calculator converts units automatically. Manually: albumin g/l ÷ 10 = g/dl (e.g. 38 g/l = 3.8 g/dl). The original publication calculated BMI as weight [lb] / height [in]² × 703, which is the same as weight [kg] / height [m]². Neutrophils and lymphocytes only need to be in the same unit, e.g. both per µl or both ×10⁹/l.
Is the cut-off "below 18" or "18 or below"?
The original publication uses ALI < 18 (high inflammation) and ALI ≥ 18 (low inflammation) in the abstract, results and tables, while the methods section mentions a split at ≤ 18 and > 18. This calculator follows the more frequently used grouping: < 18 and ≥ 18. The optimal cut point from the ROC analysis was 18.4.
Can the ALI be used in cancers other than lung cancer?
Despite its name, the ALI has been studied in several other cancers, including colorectal cancer, head and neck squamous cell carcinoma and diffuse large B-cell lymphoma. These studies used their own cut-offs (15.5 to 37.66 in one meta-analysis), so the cut-off of the study that matches the patient population should be used.
How is the ALI related to the NLR?
The neutrophil-to-lymphocyte ratio is in the denominator of the ALI. In the original study, NLR < 5 was associated with better survival in univariate analysis, and the ALI, which adds BMI and albumin, had a higher area under the ROC curve for treatment response than BMI, albumin, the neutrophil count or the lymphocyte count alone. The Naples Prognostic Score also uses the NLR, combined with albumin, cholesterol and the lymphocyte-to-monocyte ratio.
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Reference
Jafri SH, Shi R, Mills G. Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review. BMC Cancer. 2013;13:158. doi:10.1186/1471-2407-13-158
Hua X, Chen J, Wu Y, Sha J, Han S, Zhu X. Prognostic role of the advanced lung cancer inflammation index in cancer patients: a meta-analysis. World J Surg Oncol. 2019;17(1):177. doi:10.1186/s12957-019-1725-2
Zhang Y, Chen B. Prognostic value of the advanced lung cancer inflammation index in patients with lung cancer: a meta-analysis. Dis Markers. 2019;2019:2513026. doi:10.1155/2019/2513026
Written by Frederic Eberhardt, MD. Last reviewed: 18 October 2026