LIPI Calculator: Lung Immune Prognostic Index

How to interpret the LIPI

Each of the two factors counts one point. In the original study of patients with advanced non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors, the three groups had the following outcomes:

OS = overall survival, PFS = progression-free survival. Test cohort: 126 evaluable patients; validation cohort: 305 patients. In a control cohort treated with chemotherapy only, the LIPI groups did not differ significantly. These data come from patients with advanced NSCLC receiving immune checkpoint inhibitors and cannot be transferred directly to other diseases or treatments.

What is the LIPI?

The lung immune prognostic index (LIPI) combines two routine blood values that reflect systemic inflammation and tumour burden: the derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH). It was developed by Laura Mezquita, Benjamin Besse and colleagues at Gustave Roussy (Villejuif, France) and published in JAMA Oncology in 2018.

The retrospective multicenter study included patients with advanced NSCLC treated with PD-1/PD-L1 inhibitors at 8 European centers: a test set (n = 161) and a validation set (n = 305), plus a control cohort treated with chemotherapy only (n = 162). In the pooled immunotherapy cohort (n = 466), 65% of patients were male, the median age at diagnosis was 62 years and 58% had adenocarcinoma. Blood values were measured before the start of treatment. In the test cohort, dNLR > 3 (hazard ratio 2.22, 95% CI 1.23–4.01) and LDH > ULN (hazard ratio 2.51, 95% CI 1.32–4.76) were independently associated with overall survival. The association of the LIPI with survival was reproduced in the validation cohort, but was not significant in the chemotherapy cohort.

Later studies

A meta-analysis of 35 studies with 9959 patients with NSCLC or other solid tumours treated with immune checkpoint inhibitors confirmed the three-group stratification. Compared with a good LIPI, the pooled hazard ratio for overall survival was 1.69 (95% CI 1.55–1.85) for an intermediate and 3.03 (95% CI 2.53–3.63) for a poor LIPI; for progression-free survival, it was 1.41 (95% CI 1.31–1.52) and 2.23 (95% CI 1.87–2.66) (Guo et al., 2024). A meta-analysis restricted to NSCLC (21 studies, 9010 patients) found that an elevated LIPI was associated with poorer overall survival (hazard ratio 2.50, 95% CI 2.09–2.99) and progression-free survival (hazard ratio 1.77, 95% CI 1.64–1.91) (Wang et al., 2024).

Scoring

dNLR = absolute neutrophil count / (white blood cell count − absolute neutrophil count). Both counts only enter as a ratio, so any unit can be used as long as it is the same for both. The upper limit of normal for LDH was defined by each center's laboratory.

Example: leukocytes 8000/µl and neutrophils 6200/µl give a dNLR of 6200 / 1800 = 3.44 (1 point). With LDH 210 U/l and an upper limit of normal of 250 U/l (0 points), the LIPI is 1 point (intermediate).

Limitations

• The index was developed in a retrospective study. The authors point out missing data, a high rate of unknown PD-L1 status and radiological assessment performed locally at each center.
• The LIPI is prognostic: it was associated with outcomes under immune checkpoint inhibitors, but not under chemotherapy. Whether it can identify patients unlikely to benefit from immunotherapy was raised by the authors as a hypothesis, not proven. Some patients in the poor LIPI group still achieved clinical benefit.
• The upper limit of normal for LDH differs between laboratories, so the same LDH value may count as normal in one center and elevated in another.
• The dNLR cut-off of 3 was not derived in this cohort but taken from a study of patients with melanoma treated with ipilimumab (Ferrucci et al., 2016).
• Neither component is specific: the dNLR is affected by infections and corticosteroids, and LDH by haemolysis and tissue damage of any cause.

Frequently asked questions

What is the difference between the dNLR and the NLR?

The neutrophil-to-lymphocyte ratio (NLR) divides the neutrophil count by the lymphocyte count. The derived NLR (dNLR) divides it by the white blood cell count minus the neutrophil count, i.e. by all non-neutrophil leukocytes. It can therefore be calculated from the leukocyte and neutrophil counts alone. The two ratios are not interchangeable, and the cut-off of 3 applies to the dNLR.

How do I convert units for the LIPI?

The calculator converts the cell counts automatically: 1 ×10⁹/l = 1 ×10³/µl = 1000/µl. Leukocytes and neutrophils only enter as a ratio, so both just need to be in the same unit. LDH is only compared with the upper limit of normal, so LDH and the upper limit must be entered in the same unit (e.g. both in U/l).

Which upper limit of normal should I use for LDH?

The upper limit of normal stated by the laboratory that measured the LDH. In the original study, the upper limit was defined according to the limit of each center rather than a single fixed value.

Can the LIPI be used in cancers other than lung cancer?

Despite its name, the LIPI has been studied in other solid tumours treated with immune checkpoint inhibitors. The meta-analysis by Guo et al. (2024) included NSCLC and other solid tumours and found the same three-group stratification for overall and progression-free survival.

Does a poor LIPI mean that immunotherapy should not be given?

No such recommendation can be derived from the LIPI alone. The original study was retrospective, and the authors described the use of the LIPI for identifying patients unlikely to benefit from immunotherapy as a hypothesis. Some patients with a poor LIPI still achieved clinical benefit.

Related calculators

• ALI (Advanced Lung Cancer Inflammation Index) using BMI, albumin and NLR
• Naples Prognostic Score using albumin, cholesterol, NLR and LMR
• HALP Score using hemoglobin, albumin, lymphocytes and platelets
• CALLY Index using CRP, albumin and lymphocytes

Reference

Mezquita L, Auclin E, Ferrara R, et al. Association of the lung immune prognostic index with immune checkpoint inhibitor outcomes in patients with advanced non-small cell lung cancer. JAMA Oncol. 2018;4(3):351-357. doi:10.1001/jamaoncol.2017.4771

Guo Y, Pan Y, Wan J, Gong B, Li Y, Kan X, Zheng C. Prognosis stratification of cancer patients treated with immune checkpoint inhibitors through lung immune prognostic index: a meta-analysis and systematic review. BMC Cancer. 2024;24(1):523. doi:10.1186/s12885-024-12271-0

Wang Y, Lei Y, Zheng D, Yang Y, Luo L, Li J, Xie X. Prognostic value of lung immune prognostic index in non-small cell lung cancer patients receiving immune checkpoint inhibitors: a meta-analysis. Pathol Oncol Res. 2024;30:1611773. doi:10.3389/pore.2024.1611773

Ferrucci PF, Ascierto PA, Pigozzo J, et al. Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab. Ann Oncol. 2016;27(4):732-738. doi:10.1093/annonc/mdw016

Written by Frederic Eberhardt, MD. Last reviewed: 25 October 2026