Indicators associated with outcomes of in-hospital ischemic stroke

In-hospital ischemic stroke (IHIS) has been reported to be associated with various comorbidities and often leads to poor outcomes. We aimed to investigate the clinical characteristics and indicators of outcomes of patients with IHIS via a multicenter stroke registry.

Consecutive acute ischemic stroke patients were enrolled from five primary stroke centers between July 2020 and Dec 2022. For IHIS patients, data about various underlying conditions and biological markers, such as hemoglobin, albumin, C-reactive protein, and D-dimer levels, were retrospectively collected. Additionally, stroke outcomes, namely, 3-month modified Rankin scale (mRS) scores indicating poor functional outcomes (mRS score of 3-6), were assessed.

Of the 3614 consecutive acute ischemic stroke patients, 168 patients (4.6 %) were enrolled in the IHIS group. The most common diagnosis leading to hospitalization was cardiovascular disease (n = 55), followed by cancer (n = 45) and infections (n = 24). The time from recognition to assessment was longest for patients with cardiovascular disease who underwent surgery, followed by patients with infections and patients with cancer who did not undergo surgery, and the reperfusion therapy rate was lower in these groups. Multivariable analysis revealed that increased D-dimer levels were independently associated with poor stroke outcomes (odds ratio: 1.12, 95 % CI: 1.02-1.23) after adjusting for baseline clinical characteristics, including initial stroke severity.

The conditions underlying IHIS are diverse, with differences in the time from recognition to assessment and varying rates of reperfusion therapy. The D-dimer level was identified as a factor that is independently associated with poor outcomes, regardless of the underlying conditions.