ABSTRACT NUMBER: ESOC2026A995 PREDICTORS OF FUNCTIONAL OUTCOME IN YOUNG ADULTS WITH ISCHEMIC STROKE: RESULTS FROM A PROSPECTIVE REGIONAL COHORT

Abstract Background and aims Between 9-15% of ischemic strokes affect young adults (18-55 years), representing a substantial socioeconomic burden, with an increasing incidence reported in recent years. The aim of our study was to characterize risk factors, clinical presentation, etiology, acute-phase treatments and functional outcomes in this population. Methods We conducted a multicenter, prospective observational study including patients aged 18-55 years evaluated as Stroke Codes in two Stroke Units in the Valencian Community (Spain) between December 2023 and April 2025. A total of 76 demographic, clinical, laboratory, imaging, therapeutic and functional variables were collected. Results A total of 184 patients were included (median age 49 years; 64% men). There was a high prevalence of traditional vascular risk factors (smoking 49%, obesity 45%, hypertension 41%) coexisting with non-classical factors (autoimmunity 10%, cannabis use 10%). Median baseline NIHSS was 9, showing a significant correlation with the 90-day mRS (ρ=0.41; p<0.001). 63% received reperfusion therapy in the acute phase. At discharge, 41% had an undetermined etiology and 21% uncommon etiology; after follow-up, 24% of initially undetermined were reclassified as uncommon etiology. Among biomarkers, D-dimer showed the strongest association with baseline NIHSS (r=0.61), highlighting the interplay between procoagulant and inflammatory pathways. In the multivariable model, baseline NIHSS was the strongest predictor of poor functional outcome (OR=1.07; p=0.03; AUC=0.74). Conclusions Young adults with ischemic stroke exhibit a high burden of vascular risk factors and heterogeneous etiologies requiring a broader diagnostic work-up. Baseline NIHSS emerged as the main predictor of poor functional outcome in our cohort. Conflict of interest Diana Lucía Tarruella Hernández: this study was supported by the Spanish Society of Neurology "Proyecto Ictus 2023" grant, awarded by the Cerebrovascular Diseases Study Group; no personal conflicts of interest to disclose. Elisa Ginés Murcia: nothing to disclose. Carlos Lapeña López: nothing to disclose. Antonio García Molina: nothing to disclose. Manuel Pedrero-Prieto: nothing to disclose. Lluis Morales Caba: nothing to disclose. Gerardo Fortea: nothing to disclose. Irene Escudero Martínez: nothing to disclose. Nicolás López: nothing to disclose. José Ignacio Tembl: nothing to disclose.