Abstract TP254: The Incidence Rate and Risk Factors of In-Hospital Onset Stroke Among 83,990 Hospitalized Patients

Abstract

Introduction: Clinical characteristics of patients with in-hospital onset stroke (IHOS) compared to those with out-of-hospital onset stroke are reported to be late detection of stroke onset, less use of rt-PA, presence of atrial fibrillation, and poor outcome. Among hospitalized patients, however, clinical characteristics of patients with IHOS has not been clear. The purpose of this study is to clarify the incidence rate of IHOS among hospitalized patients and to investigate the risk factors associated with IHOS. Methods: Patients consecutively admitted to the Nippon Medical School hospital between April 2018 and March 2023 were assessed. Patients under 18 years and discharged within 24 hours were excluded. Furthermore, patients admitted in Neurology and Neurosurgery also were excluded to remove in-hospital onset recurrent stroke from our study. First, we calculated the incidence rate of IHOS among hospitalized patients. Next, all patients were divided into two groups, Stroke group had IHOS and Control group did not, and investigated the risk factors associated with IHOS using multivariate analysis. Results: Of 98,225 patients hospitalized, 83,990 patients (median age was 69 [54-77] years and 55.3% were male) were enrolled into this study. The number of IHOS patients were 101. Thus, the incidence rate of IHOS was 0.12%. A half of them (n=49) had stroke onset within 1 week after admission. Stroke group had higher mortality (14.9% vs. 2.7%, p < 0.01) and longer length of stay (36 days vs. 8 days, p < 0.01) than Control group. Multivariate analysis demonstrated that risk factors associated with IHOS were old age (OR 1.03, p < 0.01), hypertension (OR 1.57, p = 0.04), diabetes mellitus (OR 1.61, p = 0.03), atrial fibrillation (OR 2.43, p < 0.01), emergency admission (OR 3.38, p < 0.01) and low serum albumin level (OR 0.66, p = 0.03). Conclusions: Among 83,990 hospitalized patients, the incidence rate of IHOS was 0.12%. Risk factors associated with IHOS were old age, hypertension, diabetes mellitus, atrial fibrillation, emergency admission and low serum albumin level. Therefore, among hospitalized patients, cases with emergency admission and cerebrovascular risk factors including atrial fibrillation should be payed attention to prevent in-hospital onset stroke.