Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p #x3c; 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p #x3c; 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p #x3c; 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p #x3c; 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.
Cerebrovasc Dis Extra 2019;9:129–138

中文翻译：

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活动性癌症和D-二聚体升高是医院内缺血性卒中的危险因素。

背景与目的：尽管预后较差，从中风发作到治疗的时间较长，但对院内卒中的发病机理却很少关注。我们研究了病理生理学和生物标记物，以检测进展为院内缺血性卒中（IHS）的患者。方法： 2011-2017年期间依次招募了79名IHS患者。使用德岛大学卒中注册中心的前瞻性数据库，将他们的特征，护理和结局与933例院外缺血性卒中（OHS）患者进行了比较。结果： IHS患者中活动性癌症和冠状动脉疾病的患病率高于OHS患者（分别为53.2和27.8％对2.0和10.9％； p＃x3c; 0.001），中位开始评估时间更长（300 vs.240分钟; p = 0.015），病因未定明显更高（36.7 vs.2.4 ％; p＃x3c; 0.001）。尽管两组之间的卒中严重程度无明显差异，但IHS患者出院时的改良兰金评分（mRS）评分（3–6）更高（67.1 vs. 50.3％；p = 0.004）和死亡率住院率（16.5比2.9％；p＃x3c； 0.001）。D-二聚体（5.8 vs. 0.8 µg / mL; p＃x3c; 0.001）和纤维蛋白原（532 vs. 430 mg / dL; p倾向评分匹配后，IHS患者的发病时血浆水平显着升高（= 0.014）。多元逻辑回归分析显示，活动性癌症（比值比[OR] 2.30； 95％可信区间[CI] 1.26–4.20），中风前mRS评分3-5（OR 6.78； 95％CI 3.96–11.61），女性（OR） 1.57； 95％CI 1.19–2.08）和年龄≥75岁（OR 2.36； 95％CI 1.80–3.08）与不良预后相关。结论： IHS患者比OHS患者的预后较差，因为活动性癌症的患病率更高，中风发作前的功能依赖性更高。血浆D-二聚体和纤维蛋白原的水平升高，尤其是患有活动性癌症的血浆水平，可以帮助确定罹患IHS风险较高的患者。
Cerebrovasc Dis Extra 2019; 9：129–138