title: Neutrophil-to-Lymphocyte Ratio Predicts Length of Stay and Acute Hospital Cost in Patients with Acute Ischemic Stroke.
abstract: BACKGROUND
  Although several risk factors for prolonged length of stay (LOS) and increased hospital cost have been identified, the association between LOS, hospital cost, and neutrophil-to-lymphocyte ratio (NLR) has not yet been investigated. We aimed to investigate the influence of NLR on LOS and hospital cost in patients with acute ischemic stroke.
  
  
  METHODS
  Patients with acute ischemic stroke diagnosed within 24 hours of symptom onset were included. Univariate analysis and stepwise multiple regression analysis were used to identify independent predictors of LOS and hospital cost.
  
  
  RESULTS
  A total of 346 patients were included in the final analysis. The median LOS was 11 days (range 8-13 days). The median acute hospital cost per patient was 19,030.6 RMB (U.S. $ 3065.8) (range 14,450.8 RMB-25,218.2 RMB). Neutrophil count to lymphocyte count (NLR) (P < .001), diabetes mellitus (P = .034), stroke subtype (P = .005), and initial stroke severity (P < .001) were significantly associated with prolonged LOS in the univariate analysis. NLR (P < .001), smoking (P = .04), stroke subtype (P < .001), initial stroke severity (P < .001), and LOS (P < .001) were significantly associated with increased hospital cost in the univariate analysis. Multivariate regression analysis showed that NLR was an independent predictor of both LOS and acute hospital cost. In addition, high NLR was significantly correlated with poor outcome at discharge, prolonged LOS, and increased hospital cost.
  
  
  CONCLUSIONS
  NLR is significantly associated with LOS and acute hospital cost in patients presenting with acute ischemic stroke. It is a simple, inexpensive, and readily available biomarker and may serve as a clinically practical indicator for assessing the economic burden of stroke.
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Dai
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Xiangliang
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China.
authors.forename: Shizhan
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Ruifeng
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Shuhong
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yang
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: zhangrenliang@nju.edu.cn.
authors.forename: Renliang
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009504:Neutrophils / Q000473:pathology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy
keywords: LOS; NLR; acute ischemic stroke; hospital cost