Abstract： Objective:To explore clinical characteristics and potential risk factors for poor prognosis in patients with symptomatic in-hospital stroke.Methods:This is a prospective case control study. In-hospital stroke patients in Fuwai Hospital from January 2023 to September 2023 were enrolled. The clinical characteristics, laboratory tests, surgical information during hospitalization, and National Institute of Health Stroke Scale (NIHSS) score at the time of stroke onset were collected. Patients were followed up at 3-month after in-hospital stroke and the modified Rankin scale was used to evaluate the neurological function. The score of 0-1 indicated good outcome, whereas≥2 indicated the poor outcome.Results:One hundred and fourteen patients with symptomatic stroke were included. The average age was (61.88±12.41) years. Among them, 36 (31.58%, 36/114) were female. Ten (8.77%, 10/114) patients were with prior stroke and 17 (14.91%, 17/114) patients were with history of atrial fibrillation (AF). The NIHSS score at onset was significantly positively correlated with urea nitrogen ( r=0.27, P=0.004) and D-dimer ( r=0.30, P=0.001) at admission. At 3-month after in-hospital stroke, 68 (59.65%, 68/114) patients had good functional outcome, whereas 46 (40.35%, 46/114) patients had poor outcome. The history of AF ( OR=4.974, 95% CI 1.147-21.562), moderate ( OR=11.195, 95% CI 3.679-34.072), and severe ( OR=25.043, 95% CI 2.744-228.572) severity of stroke assessed by NIHSS maybe the independent risk factors for poor outcome. Conclusion:Patients with symptomatic in-hospital stroke had a higher risk for poor outcome, and history of AF and the NIHSS score may be independent risk factors for poor outcome.