Admission prognostic factors for functional outcomes in young adults with ischemic stroke: a prospective study

Abstract

Background: The incidence of ischemic stroke in young adults has risen over the past decades, representing a major cause of functional disability with considerable socioeconomic burden. Early identification of prognostic factors based on admission data may inform clinical decision-making and guide rehabilitation planning, particularly in low- and middle-income countries, remains limited. Objective: To identify social, clinical, and radiological factors at admission associated with functional outcomes in young adults with ischemic stroke. Methods: This prospective observational study enrolled patients aged 18 to 49 years admitted in a stroke unit in Salvador, Brazil, between 2022 and 2025. Sociodemographic variables, cardiovascular risk factors, neurological severity at admission, stroke clinical subtype and ischemic extent on computed tomography were analyzed. Functional outcome at 90 days was assessed using the modified Rankin Scale, categorized as functional independence (0-2) and functional dependence or death (3-6). Statistical analyses included Pearson's chi-square test, Fisher's exact test, Mann-Whitney U test, and multivariable logistic regression (p<0.05). Results: A total of 134 patients were included. Mean age was 42.8 ± 6 years, 54.9% were women, and 84.4% were of African descent. Systemic arterial hypertension was present in 56.7%, diabetes mellitus in 11.2%, and dyslipidemia in 13.4%. All patients (100%) were functionally independent prior to the acute stroke episode (mRS 0-2). Median admission NIHSS was 8 (IQR 4-14) and median ASPECTS was 10 (IQR 9-10). 52.2% underwent thrombolysis. According to the Oxfordshire Community Stroke Project (OCSP) classification, 53% had partial anterior circulation infarction, 22.4% lacunar infarction, 14.9% total anterior circulation infarction, and 9.7% posterior circulation infarction. At 90 days, 34.3% had functional dependence or died. In comparative analysis, admission NIHSS, ASPECTS, and clinical subtype were associated with functional outcome. In multivariable analysis, higher NIHSS (OR=1.206; 95% CI 1.089-1.336) and lower ASPECTS (OR=0.721; 95% CI 0.531-0.979) were associated with unfavorable outcomes. Compared to lacunar infarction, partial anterior circulation infarction (OR=0.283; 95% CI 0.094-0.855) and posterior circulation infarction (OR=0.074; 95% CI 0.007-0.816) had lower odds of poor outcome. Age, sex, and thrombolysis were not significantly associated with outcome. Conclusion: In young adults with ischemic stroke, neurological severity at admission, ischemic extent, and clinical subtype according to OCSP classification are predictors of functional disability at 90 days. These findings reinforce the importance of early risk stratification to optimize therapeutic management and rehabilitation strategies in this population.