Supplementary Material for: Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke

<b><i>Background and Purpose:</i></b> 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). <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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; <i>p</i> &lt; 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; <i>p</i> = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; <i>p</i> &lt; 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%; <i>p</i> = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; <i>p</i> &lt; 0.001). D-dimer (5.8 vs. 0.8 µg/mL; <i>p</i> &lt; 0.001) and fibrinogen (532 vs. 430 mg/dL; <i>p</i> = 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. <b><i>Conclusions:</i></b> 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.