Objective:

This study aims to investigate the etiologies and mechanisms of in-hospital stroke and to provide data for identifying the population at risk.

Background:

In-hospital stroke has a poor prognosis. Most studies have focused on delays in the acute-phase treatment of in-hospital stroke, prognostic analysis and improvement measures, and few studies have focused on the etiologies and mechanisms of in-hospital stroke and its prevention.

Design/Methods:

Patients with in-hospital acute ischemic stroke at a single center from June 2012 to April 2022 were consecutively enrolled. Demographic data, inpatient units, characteristics of stroke, common risk factors, laboratory tests and radiologic findings were collected. The TOAST stroke etiology and mechanism were determined by two experienced neurologists. The primary outcome was set as favorable functional outcome at discharge (mRS score 0-2).

Results:

A total of 204 patients were included, with a median age of 64 (IQR 52-72) and 61.8% male. In-hospital stroke accounts for 16.9% of all acute ischemic stroke admissions. The most common TOAST etiology was other causes (36.8%), with no statistical difference between perioperative and non-perioperative patients (P=0.061). The most common mechanism was embolism (57.8%), followed by hypoperfusion (42.2%), hypercoagulation (36.3%), small vessel mechanism (19.1%), discontinuation of antithrombotic drugs (13.2%), and iatrogenic injury (9.8%). Iatrogenic injury, hypoperfusion, embolism, and discontinuation of antithrombotic drugs were more common in perioperative stroke. 48.8% patients met the primary endpoint. Median NIHSS improvement (2 vs 1, P=0.002) and median mRS improvement (1 vs 0.5, P=0.016) at discharge were higher in perioperative patients. Advanced age and hypoperfusion were associated with poor prognosis.

Conclusions:

The etiologies and mechanisms of in-hospital stroke are complex and significantly different from that of community-onset stroke. Perioperative and non-perioperative in-hospital stroke have different mechanisms and prognostic features. Identifying the etiologies and mechanisms of stroke will help to prevent and treat in-hospital stroke appropriately.