Background It is difficult to predict the short prognosis of tuberculous meningitis (TBM), no study reported the neutrophil lymphocyte ratio(NLR) as a predictor of short prognosis in TBM and the relationship between NLR and the severity of TBM. We hypothesized that NLR is an indicator to reflect independent prognostic significance in patients with TBM and there is a correlation between NLR and the severity of TBM. This study aimed to know the role of the neutrophil lymphocyte ratio as a predictor of 28-mortality and the relationship with the severity of TBM in patients with TBM. Methods We retrospectively collected data from patients diagnosed with TBM in the West China Hospital, Sichuan University, from the period between January 1st, 2018 and August 1st, 2019. Multivariable analysis was executed by the logistic regression model to verify the independence of the 28-day mortality, Spearman correlation analysis was performed to discuss correlation about and the severity of TBM. Results A total of 231 patients were enrolled. 68 (29.4%) patients were classified as stage I. 142(61.5%) patients were stage II.25(10.8) patients were stage III. 16(6.9%) patients died during the follow-up period of 28 days. By multiple logistic regression analyses, the NLR(OR = 1.066, 95% CI = 1.002–1.133, p = 0.043), peripheral neurological deficit (OR 7.485, 95% CI2.010-27.876, P = 0 .003)and hydrocephalus (OR 11.329, 95% CI 2.395–53.583, P = 0 .002) were associated with the independent risks of 28-day mortality. Spearman correlation analysis showed the severity of TBM was significantly positively correlated with the NLR(r = 0.216, p = 0.01). Conclusions NLR, peripheral neurological deficit and hydrocephalus were independent predictors of short prognosis and NLR was significantly positively correlated with the severity of TBM.