In-Hospital Stroke Risk-State Classification from PPG-Derived Hemodynamic Features

The scarcity of temporally aligned pre-event physiological data limits the study of stroke risk states before documented clinical recognition. We focus on patients who experienced stroke during hospitalization while undergoing continuous monitoring, enabling retrospective analysis of pre-anchor photoplethysmography (PPG). Using MIMIC-III and MC-MED, an LLM-assisted pipeline generated candidate stroke anchors from unstructured notes. All retained anchors underwent physician adjudication, and a stratified 100-case double-review audit showed 95.0% candidate-to-adjudicated agreement within +/-15 min. We identified 176 MIMIC-III patients and 154 MC-MED patients with eligible synchronized pre-anchor PPG. A fixed 17-channel hemodynamic representation and ResNet-1D classifier were evaluated using patient-level five-fold internal validation and frozen external testing. At validation-selected operating points, F1-scores were 0.7956, 0.8759, and 0.9406 for 4-, 5-, and 6-hour horizons in MIMIC-III and 0.9256, 0.9595, and 0.9888 in MC-MED; the corresponding threshold-free AUCs ranged from 0.6124 to 0.7079. The PPG model achieved higher F1 than four non-waveform clinical and structured-EHR comparators in all six cohort-horizon settings. On high-risk non-stroke controls, window-level false-positive rates ranged from 0.1371 to 0.2938 and decreased to 0.0183-0.1739 after persistence aggregation. These retrospective findings support measurable pre-anchor PPG structure, but do not establish biological stroke onset, a calibrated bedside alarm, or a clinically validated prediction lead time.