Objective To systematically evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and prognosis of patients with lower extremity peripheral arterial disease (PAD). Methods Studies on NLR and lower extremity PAD were retrieved from PubMed, Scopus, Web of Science, CNKI, Wanfang data, VIP and SinoMed till Dec. 31, 2021. First author, publication year, country, study type, sample size, gender, age, smoking, comorbidity, average NLR, NLR threshold, outcome and follow-up time were collected. The quality of the included studies was evaluated with Newcastle-Ottawa scale. Stata 16.0 software was used to calculate the effect size of different outcomes in lower extremity PAD patients with high or low NLR by random-effect model. Results A total of 17 articles were included (n＝4 554). Meta analysis showed that all-cause death, amputation and restenosis were closely associated with high NLR and the combined effect sizes were hazard ratio (HR)＝1.93 (95% confidence interval ［CI］ 1.21-3.10), HR＝1.92 (95% CI 1.43-2.59) and odds ratio (OR)＝1.76 (95% CI 1.13-2.75), respectively. Subgroup analysis suggested that high NLR was predictive of all-cause death, amputation and restenosis in lower extremity PAD patients within 1 year after intervention, with HR being 3.24 (95% CI 1.96-5.35), HR being 2.64 (95% CI 2.10-3.31) and with OR being 2.44 (95% CI 1.09-5.43), respectively. HR of all-cause death in lower extremity PAD patients with high NLR treated conservatively was 2.82 (95% CI 2.08-3.84), while high NLR was not associated with amputation. Conclusion High NLR is closely associated with all-cause death, amputation and restenosis after intervention, which can be used as a predictor of amputation, all-cause death and in-stent restenosis in lower extremity PAD patients 1 year after intervention.