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Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.
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Objective To optimize the process of hyperglycemia management in hospitalized diabetic patients,to standardize behaviors of medical staff and reduce the incidence of adverse events.Methods The team of hyperglycemia management was established to reformulate flowchart of hyperglycemia management for diabetic patients,and to design and implement the intervention scheme by applying Healthcare Failure Mode and Effect Analysis (HFMEA).Results After the application of HFMEA,the reporting rate of hyperglycemia was increased from 74.56％ to 77.98％,the rate of insulin injection was increased from 91.12％ to 94.08％;the qualification rate of theoretical knowledge among nurses was increased from 56.25％ to 93.75％,the qualification rate of insulin injection practice was increased from 43.75％ to 93.75％;the incidence of adverse events related to insulin injection was decreased from 7.31‰ to 1.9‰.The differences were statistically significant (P＜0.05).Conclusion Utilization of HFMEA to optimize the process of hyperglycemia management can effectively standardize behaviors of medical staff and reduce the incidence of adverse events associated with insulin injection.