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IgA vasculitis (IgAV) is a small-vessel leucocytoclastic cutaneous vasculitis, often associated with kidney and gastrointestinal (GI) manifestations. Although predictive factors for systemic involvement have been extensively studied in children, there is paucity in the literature regarding adult patients. Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker, used to assess systemic inflammation in various diseases.We sought to evaluate whether NLR can be used for predicting renal and GI involvement in adult IgA vasculitis patients.This was a retrospective review of adult patients who were diagnosed with IgAV at our institution between 2004 and 2016.A total of 40 patients met our inclusion criteria. Half of the enrolled patients had clinical symptoms suggestive of systemic involvement, of which 6 (15%) had only renal, 3 (7.5%) had only GI and 11 (27.5%) had both renal and GI involvement. Pretreatment NLR was significantly associated with renal and/or GI manifestations of the disease (P < 0.001). The optimal cut-off value of NLR, for predicting systemic involvement was 3.34, with a specificity of 95% and a sensitivity of 85%. In addition, pretreatment NLR was also found to be significantly correlated with the severity of the systemic manifestations of IgAV (P = 0.022).This study suggests that NLR is a potential indicator for prognosticating systemic involvement in adult IgAV.