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This study aimed to elucidate the association between the neutrophil-to-lymphocyte ratio (NLR) and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM).A retrospective study was performed on patients treated with TTM after OHCA. Patients were divided into two groups according to their calculated NLRs (NLR < 6 and NLR ≥ 6). The primary outcome was poor neurological outcome at 6 months as defined by a Cerebral Performance Category between 3 and 5.A total of 216 were included and 131 subjects had poor neurological outcomes at 6 months. In the univariate model, NLRs ≥ 6 at 48 and 72 h after ROSC were associated with poor neurological outcomes (OR: 3.716, 95% CI: 1.243–11.114; OR: 7.429, 95% CI: 3.693–14.945, respectively). In the multivariate logistic regression analysis, an NLR ≥ 6 at 72 h was associated with poor neurological outcomes after adjusting for history of HTN, shockable rhythm, cardiac cause of arrest and time from collapse to ROSC and highest WBC, hs-CRP, lactate and pneumonia (OR = 3.299, 95% CI = 1.080–10.081).An NLR ≥ 6 at 72 h after the ROSC is associated with poor neurological outcomes at 6 months after CA.An NLR ≥ 6 at 72 h after the ROSC was associated with poor neurological outcomes at 6 months post-CA after treatment with TTM.An NLR ≥ 6 at admission was not associated with poor neurological outcomes at 6 months post-CA after treatment with TTM.Our study increases the importance of serializing blood tests.