| Background and Purpose:Stroke is the leading cause of death and adult disability n China, with the annual mortality rate of 157 per 100,000. Stroke has become a considerable economic burden on china’s health care system. In 2003, the direct medical cost for stroke is 37.452 billion RMB, involving 237.32 billion RMB of ischemic stroke and 137.52 billion RMB of hemorrhagic stroke in China. Length of stay (LOS) becomes the greatest direct economic burden, involving 70% of the total stroke cost. Several factors of hospital cost and LOS have been identified such as stroke severity, complications during hospital stay, stroke subtype, stroke risk factors (atrial fibrillation, hypertension, diabetes mellitus, and smoking), and age. The inflammatory response has been found to be implicated in all stages of ischemic stroke, including the cerebral necrosis triggered by the interruption of cerebral blood flow of the early stage to the recovery and repair after cerebral ischemia of the late stage. Neutrophils are recruited to the focal ischemic brain and may potentiate injury by directly releasing deleterious substances or other inflammatory mediators. Neutrophils accumulating in cerebral vessels within hours may plug cerebrovascular microvessels, impede microvascular perfusion, and contribute to extension of infarctions in transient cerebral ischemia. When neutrophil infiltration is inhibited, the infarct volume is significantly reduced and neurological outcome is improved. Lymphocytes may play a protective role by releasing anti-inflammatory cytokines and repairing the inflamed tissues. They also have a deleterious role associated with the development of inflammation, with different subtypes of lymphocytes with different roles in response to cerebral ischemia. Neutrophil-to-Lymphocyte Ratio (NLR) has been observed as a better predictive marker than total WBC count or neutrophil count in cardiovascular diseases and is independently associated with the severity of coronary artery disease and progression of atherosclerosis in patients undergoing angiography. NLR was associated with infarct volume, prognosis and might be a predictor of short-term mortality in acute stroke patients. Whether NLR is independently related to LOS and acute hospital cost is unknown. Therefore, the purpose of the current research is to identify the relationship between NLR and hospital cost and LOS in patients with acute ischemic stroke.Method:Consecutive patients with acute ischemic stroke diagnosed within 24-hour of symptom onset were included from Nanjing stroke registration system. Vascular risk factors (alcohol drinking, smoking, diabetes mellitus, hypertension, coronary heart disease, myocardial infarction and atrial fibrillation); hospital cost; LOS; demographic data (sex and age); time from stroke onset to admission; laboratory parameters (neutrophil counts, total WBC, lymphocyte counts, low-density lipoprotein cholesterol, total cholesterol, triglycerides and high-density lipoprotein cholesterol) were collected. Univariate analysis and multiple regression analysis were used to identify predictive factors of hospital cost and LOS.Results:346 patients with acute ischemic stroke were included in the final analysis. The mean age was 60.8±12.5 years, and 243 (70.2%) patients were male. The median acute hospital cost was 19030.6 RMB (US$ 3065.8) (range,14450.8-25218.2 RMB). The median LOS was 11 days (range,8-13 days). NLR (p<0.001), initial stroke severity (p<0.001), stroke subtype (p=0.005) and diabetes mellitus (p=0.034) were significantly related to prolonged LOS in univariate analysis. NLR (p<0.001), LOS (p<0.001), stroke subtype (p<0.001), smoking (p=0.04), and initial stroke severity (p<0.001) were significantly related to increased hospital cost in univariate analysis. The independent predictive factors associated with LOS were NLR (p<0.001), NIHSS score on admission (P=0.048), diabetes mellitus (P=0.016) and non-small-vessel occlusion (P=0.044) after multivariate linear regression analysis. The independent predictive factors for acute hospital cost were NLR (P<0.001), LOS (P<0.001) and NIHSS score on admission (P=0.02) after multivariate linear regression analysis. Moreover, high NLR was significantly associated with increased hospital cost, prolonged LOS, and poor outcome at discharge.Conclusion:NLR in patients with acute ischemic stroke is significantly related to LOS and acute hospital cost. It is a inexpensive, simple and readily available biomarker and may serve as a clinically practical indicator for evaluating the economic burden of stroke. |
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