Abstract: Objective Investigate the risk factors of hospital mortality in patients with acute stroke in the elderly.And take active method to prevent acute stroke complications. Methods 1 200 cases of elderly patients with acute stroke were retrospectively analyzed.They were divided into death group and survival group according to the outcome.Multivariate Logistic regression was used to analyze the risk factors for in-hospital mortality. Results There were 75 cases died among 1 200 cases.The mortality rate was 6.25%.The ages in death group were 75.9±8.8,significantly higher than that in survival group 64.2±6.7.The cases that were hemorrhagic stroke in death group were significantly higher than that in survival group.The cases that had history of diabetes,stroke,and coronary heart disease in death group were significantly higher than that in survival group.NIHSS scores in death group were 15.8±7.4,significantly higher than that in survival group 9.5±5.6.The difference had statistical significance(t=9.223,P＜0.05).Glasgow scores in death group were 9.3±3.1,significantly lower than that in survival group 12.6±4.9.The difference had statistical significance(t=5.755,P＜0.05).The cases who received central venous catheter,catheter,and nasogastric tube in death group were significantly higher than that in survival group.High fever,pulmonary infection,urinary tract infection,cerebrocardiac syndrome,gastrointestinal bleeding and venous thrombosis of lower extremity occurred in in death group was significantly higher than that in survival group.Multivariate Logistic regression analysis showed that low Glasgow Coma Score,pulmonary infection,combined with brain heart syndrome and upper digestive tract bleeding and history of diabetes were independent risk factors of death in hospital. Conclusion There are many risk factors of death in patients with acute cerebral stroke in elderly.Low Glasgow Coma Score,pulmonary infection,brain heart syndrome and upper digestive tract bleeding and history of diabetes were independent risk factors of death.We should pay more attention to these patients.