Risultati per: La nevralgia post-erpetica

Stroke, Volume 56, Issue Suppl_1, Page A119-A119, February 1, 2025. Background:The deleterious effects of intensive blood pressure (BP) lowering in patients who achieved successful reperfusion may result from high BP variability (BPV). However, there is still uncertainty regarding whether the association between high BPV and poor outcomes indicates a causal relationship or if high BPV is merely a bystander or consequence of various factors associated with poor outcomes. We investigated whether the association between intensive BP management after endovascular therapy (EVT) and unfavorable functional outcomes is mediated by BPV.Methods:This is a secondary analysis of OPTIMAL-BP (The Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control), comparing intensive and conventional systolic BP (SBP) management for functional outcomes in patients with successful reperfusion post-EVT. Multivariable logistic regression analysis was conducted for the association between BPV and outcomes including 90-day modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH), and final infarction volume. Mediation analysis was performed to evaluate the causal inference whether the relationship between intensive BP management and the 90-day mRS is mediated by BPV.Results:The 24-hour time rate (TR) of SBP was significantly higher in the intensive BP management group. Higher TR was significantly associated with an unfavorable ordinal shift of the 90-day mRS (adjusted OR [aOR] 1.19, 95% CI 1.06–1.33, P=0.003). High TR significantly increased the final infarction volume (coefficient 24.03, 95% CI 6.50–41.56, P=0.007), but did not increase the risk of sICH. TR fully mediated the association between intensive BP management and functional outcomes. The proportions of the association explained by TR was 32.15%.Conclusions:TR mediated the association of intensive BP management for 24 hours and poor functional outcome in successfully reperfused ischemic stroke patients. Efforts to modulate BPV after EVT may be helpful in improving clinical outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP98-ATP98, February 1, 2025. Objectives:We evaluate the potential link between post-acute care, particularly care provided at inpatient rehabilitation facilities (IRF) (vs. home discharge or discharge to a skilled nursing facility [SNF]), and major adverse cardiovascular events (MACE) among ICH survivors.Methods:Using inpatient and emergency department data from Florida, New York, Maryland, Washington, and Georgia, we identified adult (≥18 years) spontaneous ICH survivors discharged to home (with or without home health), IRF, or SNF between April 2016 and December 2018. We fit multivariable logistic regression models and report the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the independent association of discharge disposition (IRF versus home, and IRF versus SNF) with MACE (a composite outcome of stroke, acute myocardial infarction [AMI], systemic embolism, or vascular death), recurrent primary ICH [rICH], acute ischemic stroke (AIS), AMI, and all-cause mortality within 1-year of initial ICH admission. We assessed for interaction between age and discharge disposition and performed stratified analysis among patients aged < 65 years and older patients ≥ 65 years.Results:A total of 17 647 ICH patients alive at discharge (median age [IQR]: 69[57-79]; 45.2% female; 55.5% non-Hispanic White; 23.2% non-Hispanic Black; 10.4% Hispanic; 4.9% Asian) were included, of which 8 194(46.4%), 4 506 (25.5%), and 4 947(28%) were discharged to home, IRF, and SNF, respectively. Within 1-year of follow-up, 7.4% of ICH survivors experienced MACE, while 2.5%, 3.2%, 0.6%, and 3.5%, respectively, experienced rICH, AIS, AMI, and mortality. Overall, patients discharged to IRF had lower odds of MACE (vs. home [aOR, CI: 0.79, 0.68-0.92]; vs. SNF [0.82, 0.70-0.97]; Table 1), rICH (vs. home [0.68, 0.52-0.89]; and vs. SNF [0.66, 0.49-0.88]), AMI (vs. home [0.57, 0.35-0.94]) and mortality (vs. SNF [0.57, 0.45-0.72]). A significant interaction between age and discharge destination was observed (P

Stroke, Volume 56, Issue Suppl_1, Page ATP32-ATP32, February 1, 2025. Background:Periodontal disease and dental caries are a leading cause of tooth loss which has been correlated with stroke in the REGARDS study. We investigated the correlation between tooth loss and post-stroke cognitive impairment (PSCI) assessed by Montreal Cognitive Assessment (MoCA).Methods:The MoCA was conducted in consecutive ischemic stroke and TIA patients (N=280) enrolled in PREMIERS trial (ClinicalTrials.gov NCT#02541032) based on presence of moderately severe periodontal disease. These patients were categorized as having normal/mild cognitive impairment (MoCA >19) or severe cognitive impairment (MoCA ≤19). Regarding tooth loss, patients were categorized into two separate groups based on the number of teeth lost as noted during initial assessment. The groups were categorized into those reporting significant tooth loss (≥8) and no significant tooth loss of

Stroke, Volume 56, Issue Suppl_1, Page ATP70-ATP70, February 1, 2025. Introduction:A significant proportion of stroke patients are lost to follow up (LTFU) after discharge, which may be associated with increased risk of morbidity, mortality, and unnecessary hospitalization. We aimed to identify predictors of post-discharge LTFU and unplanned hospitalizations in a cohort of patients with acute stroke from a large academic hospital system.Methods:Using our institutional AHA Get With the Guidelines quality registry, we conducted a retrospective analysis of all patients who were hospitalized for acute stroke between January 1, 2016, and December 31, 2020 at a tertiary-care hospital in New York City. Our primary outcome was post-discharge LTFU, defined as having zero post-discharge encounters within 12 months. Our secondary outcomes included having one or more outpatient visits with a provider, unplanned hospitalizations, and emergency department (ED) visits within 30 days post-discharge. Multiple logistic regression was used to identify factors that were significantly associated with our primary and secondary outcomes, adjusted for confounding demographic and clinical factors.Results:We identified 2,597 patients hospitalized for acute stroke, of which 878 (33.8%) were LTFU. Of the 1,719 patients not LTFU, 974 (56.7%) had a provider visit, 405 (23.6%) had an unplanned admission, and 257 (14.9%) had an unplanned ED visit within 30 days post-discharge. Patients who were LTFU were significantly more likely to be male (52.9% vs. 47.4%); have an intracerebral (12.1% vs. 8.9%) hemorrhage; discharged to a skilled nursing facility (19.8% vs. 17.0%); and transferred from another hospital (48.0% vs. 40.7%). Clinically, these patients are more likely to have a history of DVT/PE (3.9% vs. 1.3%); receive catheter-based treatment (12.8% vs. 10.0%); and have a modified Rankin scale (mRS) score of 3 or greater at discharge. In the multivariable logistic regression, patients who were discharged to an acute care facility (adjusted odds ratio (aOR) 3.3), had a history of DVT/PE (aOR 3.1) or a discharge mRS of 3 (aOR 1.8) had significantly higher odds of LTFU, whereas patients who were discharged to an inpatient rehabilitation facility (aOR 0.65), had a family history of stroke (aOR 0.60) or depression (aOR 0.64) had significantly decreased odds of LTFU.Conclusions:In this study, patients LTFU after a stroke were more likely to have severe clinical conditions and specific discharge dispositions.

Stroke, Volume 56, Issue Suppl_1, Page ATP34-ATP34, February 1, 2025. Background:Elevated blood pressure variability (BPV) has been associated with worse outcomes in stroke survivors. This study aimed to investigate the relationship between systolic and diastolic BPV and post-stroke cognitive impairment (PSCI) in patients with acute cardioembolic stroke due to atrial fibrillation.Methods:Using data from a prospective stroke registry, we consecutively enrolled 143 patients with acute cardioembolic stroke. Cognitive function was evaluated three months post-stroke using the Korean version of the Vascular Cognitive Impairment Harmonization Standards. PSCI was defined as a z-score of less than -2 standard deviations for age, sex, and education-adjusted means in at least one cognitive domain. Multiple logistic regression was used to assess the association between BPV during the first 7 days of admission and PSCI, adjusting for age, sex, education, vascular risk factors, initial stroke severity, and neuroimaging characteristics.Results:Among the 143 participants (mean age 70 years; 60.1% male; median initial NIHSS score of 5), PSCI was identified in 67 patients (46.9%). The standard deviations of both systolic and diastolic blood pressures were significant predictors of PSCI (aOR 1.09; 95% CI 1.01–1.17 and aOR 1.14; 95% CI 1.01–1.29, respectively). The mean values of both SBP and DBP were also significantly associated with PSCI.Conclusions:Our findings demonstrate that both systolic and diastolic BPV in the acute phase of cardioembolic ischemic stroke are independently associated with PSCI at three months. These results underscore the importance of monitoring and managing blood pressure variability in the acute stroke setting to reduce the risk of cognitive decline.

Stroke, Volume 56, Issue Suppl_1, Page AWP235-AWP235, February 1, 2025. Introduction:Insurance status may serve as an indicator of social and financial barriers that impede access to quality care. Disparities in outcomes of patients with ischemic stroke have been associated with insurance coverage. However, there are few studies investigating the impact of insurance status on outcomes in patients with intracerebral hemorrhage (ICH).Methods:We performed a post-hoc analysis of the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study to investigate the impact of insurance status on good functional outcome (modified Rankin Scale score of 0-3 at 90 days after ICH). A logistic regression model was adjusted for age, sex, race, mechanical ventilation, systolic blood pressure, smoking status, diabetes mellitus, atrial fibrillation, hypertension, congestive heart failure, Glasgow Coma Scale, ICH location (side and deep), ICH volume on CT, and presence of intraventricular hemorrhage. VA patients were excluded from analysis due to small sample size.Results:Among 1874 patients included in this study, 428 patients (22.8%) had Medicare, 347 patients (18.5%) had Medicaid, 183 patients (9.8%) had HMO, 568 patients (30.3%) had private insurance, and 348 patients (18.6%) were self-pay. Table 1 illustrates demographics by insurance status. The odds ratio for good outcome in those with private insurance was significantly higher in comparison to Medicare (OR 1.47, 95% CI 1.06-2.03, p=0.022, Figure 1). When comparing private insurance to all other insurance types, the odds ratio was 1.42 (95% CI 1.09-1.84, p=0.009).Conclusion:Amongst patients in the ERICH study, private insurance was associated with a higher likelihood of good outcome (mRS 0-3 at 90 days) in ICH patients compared to Medicare or other insurance status. Further study is needed to establish if this observation is causal or an epiphenomenon.

Stroke, Volume 56, Issue Suppl_1, Page AWP234-AWP234, February 1, 2025. Introduction:Education, a key modifiable social determinant of health, plays a significant role in shaping outcomes related to ischemic stroke. Higher educational attainment has been linked to improved management of risk factors and greater adherence to medical treatments. However, the impact of education on patients suffering from intracerebral hemorrhage (ICH) remains underexplored.Methods:We conducted a post-hoc analysis of the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study to examine the impact of educational attainment on good functional outcome (modified Rankin Scale score of 0-3 at 90 days after ICH). A logistic regression model was adjusted for age, sex, race/ethnicity, insurance status, mechanical ventilation, systolic blood pressure, smoking status, diabetes mellitus, atrial fibrillation, hypertension, congestive heart failure, Glasgow Coma Scale, ICH location (side and deep), ICH volume on CT, and presence of intraventricular hemorrhage.Results:Among 1894 individuals included in this study, 584 patients (30.8%) had less than a high school (HS) education, 539 patients (28.5%) had a HS education, 641 patients (33.8%) had more than HS or a college education, and 130 patients (6.9%) had postgraduate education. See Table 1 for demographics by education group. The predicted probability of good outcome by education level was significantly different (Figure 1). Compared to those with

Stroke, Volume 56, Issue Suppl_1, Page AWP287-AWP287, February 1, 2025. Introduction:Effective blood pressure (BP) control post-stroke is a critical secondary prevention strategy. Research shows that social determinants of health (SDOH) may influence this process by addressing underlying factors contributing to health disparities. We conducted a secondary analysis using data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study to investigate the cumulative effect of multiple SDOH domains on BP reduction in stroke survivors, with a particular focus on sex-specific outcomes.Methods:We applied the Healthy People 2020 framework to identify SDOH across the following domains: economic factors, education, social context, healthcare access, and neighborhood characteristics. Stroke survivors in the DESERVE skill-based intervention study completed a 6-month follow-up (n=361) and were classified into two groups based on the number of negative factors:

Stroke, Volume 56, Issue Suppl_1, Page ATP45-ATP45, February 1, 2025. Introduction:Standardized cognitive assessments such as the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) are generally administered using paper-and-pencil methods. Technological advancements have digitized these exams and expanded cognitive testing capabilities in the post-stroke population.Methods:Studies from 2010-2022 were identified from PubMed, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar to include digital cognitive assessments utilized for acute and chronic ischemic and hemorrhagic stroke patients. The research questions aim to evaluate technical aspects of digital tests, digital tool effectiveness, cognitive domains assessed, study population characteristics, patient usability, and exam feasibility. The methodological framework for this review included research question identification, relevant study collection, final study selection, data extraction, analysis, and summary. Covidence was used to compile relevant studies.Results:72 articles were included for final analysis. 8 different digital methods (e.g., tablet, computer, virtual reality) were used to assess cognition, with 26 studies creating a new cognitive test and 24 creating a cognitive test based on a standardized exam. Participants were tested in both acute and chronic phases (5 strictly in acute, 55 strictly in subacute/chronic, and 11 in both). 58% of articles assessed ischemic and hemorrhagic stroke participants, and 9 studies only tested aphasia patients. Exams consisted of a variety of cognitive domains, with the majority of studies testing multiple domains (e.g., executive functioning, attention, and visuospatial processing), and some studies testing only one cognitive domain. The average rate of digital test completion was 95%. Validation of the digital tool was compared with a standardized, paper-and-pencil test (e.g., MOCA, MMSE) in 48 articles (67%). An overall positive satisfaction with the digital test was seen in 8 articles that incorporated patient questionnaires.Conclusion:This review suggests that post-stroke digital cognitive assessments are feasible in the acute and post-acute settings across multiple domains similar to the MOCA and MMSE. Enhancements in these tools will expand access to testing and allow for increased identification of post-stroke cognitive impairment.

Stroke, Volume 56, Issue Suppl_1, Page AWP213-AWP213, February 1, 2025. Intracerebral Hemorrhagic (ICH) stroke is the second most common type of stroke and its aftermath is often more severe than ischemia. Recent population data has shown increasing trends of ICH in middle aged people, contributing to the economic burden of society. In order to improve post ICH outcome, immediate therapeutic interventions should be administered. Hence, our research is looking into the effects of electrical stimulation of the perihematomal cortex in the hyperacute/acute phase post ICH. The end goal is to test improvement in outcomes of subjects post the administration of such a stimulation paradigm by using the observations in experimental data to validate the theoretical model and hence design a closed loop stimulation paradigm. The two approaches in the work:Experimental:Hemorrhagic stroke is induced in minipigs by injecting 2cc of blood into the ventricular space beneath sensorimotor cortex to simulate an ICH. We insert ultra flexible microelectrodes in this region to record cortical neuronal activity and administer stimulation. Neural activity (Electrophysiological) data is collected pre/post stroke and during stimulation. The data collected is analyzed to understand changes in neural activity at different points in time. Through preliminary data analysis, we could clearly see the changes in the statistics of neural activity (pre/post ICH InterSpike Interval (ISI) histogram and firing frequency histogram). Local connectivity changes were observed in the data. Further removal of stimulation artifacts and analysis of neural data before, during and after stimulation shall be performed to understand the changes that occur during stimulation.Theoretical:We have mathematically modeled a neuron-astrocyte-vascular system in the cortical perihematoma by extending Hodgkin-Huxley biophysics to simulate pre/post acute ICH and electrical stimulation paradigms in such conditions. The results obtained help us understand the changes in the system dynamics post ICH with bifurcation analysis giving unique outlook of the complex system. The simulated data shows increase in excitability of perihematomal tissue during acute phase. Further, the model also showcases calcium ion dyshomeostasis and problems in ATP production and consumption. Normal stimulation paradigms are shown to not work in such settings. Further exploration of the intricacies of the system is at focus to better understand electrical stimulation in such cerebrovascular conditions.

Stroke, Volume 56, Issue Suppl_1, Page ATP400-ATP400, February 1, 2025. Ischemic stroke is a leading cause of death and disability in the US, occurring when the blood supply to an area of the brain is disrupted. Such vascular insults may impact different brain areas responsible for neurologic functions ranging from the generation of movement to language, executive cognitive performance, and mood. Clinicians consider strokes as macroscopic events affecting structures such as cortex, basal ganglia, thalamus, or brainstem. However, each of these is comprised of circuitry involving multiple neuronal cell types, each with stratified metabolic requirements and distinct firing patterns that impact susceptibility to ischemia. Many strokes affect neocortex, a 6-layered cellular sheet containing excitatory glutamatergic pyramidal projection neurons (~80%) and inhibitory local GABAergic interneurons (~18%) assembled into circuits that are elaborated across different cortical areas..In the weeks following a stroke many patients experience unanticipated neurologic issues that disrupt their recovery and lead to additional suffering. These secondary complications fall into the categories of mood disorders (occurring in 31% of stroke survivors), seizure (3-7%), movement disorders (4%), and cognitive decline (11%). While some therapies exist, complications are often inadequately treated and the causes remain poorly understood as they relate to specific pathologic changes in local cortical circuits. Using a combination of photothrombotic lesions and fluorescent microparticle injection as models for focal ischemic stroke, we designed experiments to define the subpopulations of cortical neuron most susceptible to cell death and dysfunction following ischemic stroke.Using genetic driver mice to label canonical GABAergic (PV, VIP, SST) and glutamatergic neuronal cell types, we provide the first quantitative evidence that neural subtypes have differential susceptibility to ischemia in peri-infarct regions, and completein vivo2-photon imaging of the onset of ischemic cell death in medial prefrontal cortex and motor cortex using virally-encoded apoptosis markers. Using a combination of Gcamp voltage sensors and EEG. we also present an approach for recurrent monitoring of post-stroke neuronal activity changes leading to organizing network hyperexcitability in ischemic penumbrae. These results lay a foundation for investigation of cell type specific therapies to mitigate the maladaptive effect local cortical disinhibition following stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP53-ATP53, February 1, 2025. Background:Post-discharge phone calls to stroke patients are a valuable tool to assess medication compliance, stroke education retention and prevention of emergency room visits. However, there is no optimal time frame defined by The Joint Commission for post-discharge follow-up calls. The purpose of this study was to determine if there is an optimal time frame to call patients and whether call fatigue affects call completion rate.Methods:Ischemic and hemorrhagic stroke patients discharged to home with and without home health from 2/2024 to 6/2024 were included. Participants received phone calls from a Stroke Certified Registered Nurse at 7 days (Group 1), 14 days (Group 2), and 21 days (Group 3) post-discharge. Two call attempts were made. Data collected included baseline demographics, call completion rates, stroke education and validation of knowledge retention. Call fatigue was assessed by capturing the number of times patient was contacted after discharge by health care team. Patients received a Knowledge Score of 0-6 based on recall of knowledge of diagnosis, stroke type, signs and symptoms of stroke, risk factors, medication knowledge and stroke prevention. R *** was used for data analysis.Results:178 patients were called, 64 (36%) Group 1, 61 (34%) Group 2, 53 (30%) Group 3. There were no differences in baseline demographics. 74% (131) of patients were reached successfully. There were no differences in completion among each group (49 {75%} Group 1, 42 {69%} Group 2, 40 {75%} Group 3) p=0.6 despite more calls being made by healthcare team members early on (7.09±4.55 in Group 1, 4.12±3.27 in Group 2, 3±2.89 in Group 3). There were no differences in Knowledge Score regardless of time phone call was made. Patients who were discharged home with home health had better Knowledge Score than those discharged home without home health (5.87(±0.61) vs 5.48(±1.36)) p=0.03.Conclusion:Implementing a post-discharge phone call program up to 21 days is feasible. There was no difference in call completion rates and retention of stroke knowledge despite a heavier call burden earlier on suggesting no call fatigue.

Stroke, Volume 56, Issue Suppl_1, Page AWP250-AWP250, February 1, 2025. Background:Subarachnoid hemorrhage (SAH) following endovascular thrombectomy (EVT) is a poorly understood phenomenon, and whether it is associated with clinical detriment is unclear.Methods:This was an explorative analysis of a national database of real-world hospitalizations in the United States. Patients who underwent EVT were included. Patients were divided into SAH and non-SAH groups, and hospitalization outcomes were compared using multivariable logistic regression models. Regression models were also used to identify significant predictors for post-EVT SAH, and significant modulators of SAH’s association with hospitalization outcomes were also assessed.Results:99,219 EVT patients were identified; 6,174 (6.2%) had SAH. Overall, SAH was independently associated with increased odds of in-hospital mortality (21.5% vs. 10.6%, adjusted OR 2.53 [95%CI 2.23-2.87], p

Stroke, Volume 56, Issue Suppl_1, Page AWP263-AWP263, February 1, 2025. Introduction:Despite evidence showing overall improvement of post-stroke outcomes following endovascular therapy (EVT), existing literature on comparative recovery rates of different stroke deficits is limited. We hypothesized that the rate of change in aphasia may vary compared to other neurological deficits in stroke patients post successful EVT.Methods:We performed a retrospective analysis of acute stroke patients at a single comprehensive stroke center who presented with aphasia and underwent EVT from 2022 to 2023 (n=122). Total and itemized NIHSS scores were documented at three separate timepoints: admission, immediately post-EVT, and at discharge; NIHSS scores were normalized by dividing each score by its maximum possible value. We also investigated the NIH Cog-4 and Motor-6 as summative scores representing domain specific cognitive and motor deficits, respectively. We analyzed the effects of TNK and successful reperfusion (TICI 2B to 3 vs 0 to 2A) on the normalized stroke deficit scores with a linear mixed-effect regression model adjusted for measurement timepoint with subjects as a random effect. We extracted each variable’s beta coefficient, representing the variable’s average effect on NIH score (e.g. average change in score from admission to post-EVT). Recovery was represented by percent changes in beta coefficient by successful vs unsuccessful reperfusion. We also evaluated the percent change in beta coefficients with a stratified analysis of ≥ TICI 2B using permutation testing (500 permutations) to test the null hypothesis that there are no change in beta coefficients between subgroups (p

Stroke, Volume 56, Issue Suppl_1, Page AWP269-AWP269, February 1, 2025. Introduction:All-cause dementia remains a significant public health concern, with stroke recognized as a key risk factor. Few studies have applied Machine Learning (ML) models to accurately predict cognitive impairment and dementia, yet none have specifically focused on post-stroke dementia risk prediction. This study aims to compare the efficacy of ML approaches and traditional biostatistical methods for predicting the incidence of one-year post-stroke all-cause dementia using electronic health record (EHR) data.Methods:We analyzed de-identified data extracted from the TriNetX network, covering 60 healthcare organizations. This study included patients aged 20+ who experienced their first stroke (any type) in 2018 (baseline). We excluded those with dementia history, lacking data 3 years after stroke onset, or without relevant health data within 3 years preceding stroke. We developed four models: Logistic regression (LR) with backward selection, regularized LR (LASSO and Ridge regression), and Random Forest (RF). The primary outcome was the incidence of all-cause dementia within one year post-stroke. Covariates included demographics, comorbidities, medications, laboratory measures, and vital signs. Model performance was evaluated using accuracy and the area under the curve (AUC) of the receiver operating characteristic (ROC).Results:The final cohort comprised 55,888 adults, of whom 8% developed all-cause dementia within the subsequent year. The sample was 48.4% female, with a distribution of 8.7% aged 20-44, 37.2% aged 45-64, and 54.0% aged 65+. About 64% were non-Hispanic Whites. Among those who developed dementia, 49.7% were female and 80.5% were 65+. They had slightly higher systolic blood pressure, lower BMI, higher rates of comorbidities, and medication use (Table 1). Performance metrics for the models were as follows: LR with backward selection (accuracy: 92.07%; AUC: 0.8033), LASSO regression (92.09%;0.8000), Ridge regression (92.04%; 0.8026), and RF (92.20%; 0.7828) (Table 2).Conclusion:This study demonstrated the feasibility of using ML models to accurately predict post-stroke all-cause dementia incidence. All models showed high accuracy and robust discriminative ability, with the RF model achieving the best accuracy and traditional LR displaying the highest AUC. ML approaches can effectively learn from the data to identify individuals at higher risk of post-stroke dementia, potentially enabling targeted interventions and improved patient care.

Introduction
This review aims to synthesise research evidence regarding biomarkers in the synovial fluid that may predict the risk of post-traumatic osteoarthritis (PTOA) in young adults. Considering the high prevalence of knee joint injuries, particularly among youth sports athletes, this review will focus on anterior cruciate ligament and/or meniscal ruptures. These injuries are highly associated with PTOA, with studies indicating that even with surgical reconstruction, 50%–80% of affected individuals develop knee PTOA within a 10-year follow-up.

Methods and analysis
The results of this systematic review will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Diagnostic Test Accuracy guidelines. Comprehensive electronic searches will be conducted across five platforms: four bibliographic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Embase) and ClinicalTrials.gov registry. These searches will use combinations of predefined keywords, such as “knee”, “synovial fluid”, “post-traumatic osteoarthritis”, “anterior cruciate ligament”, “meniscus”, “trauma”, “inflammation” and “biomarker”. We will include randomised clinical trials, non-randomised prospective or retrospective clinical studies, case controls, cohort studies and case series, ranging from database inception to 30 June 2024 and published in English. Two independent reviewers will screen and evaluate the retrieved studies to determine their eligibility. Any reviewer disagreements will be resolved through discussion and consensus or, if necessary, by consultation with a third reviewer. The data will be extracted from the included studies and analysed, with the risk of bias assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A narrative synthesis will be performed to evaluate the strength and consistency of the findings, considering both the methodological quality of the included studies and the reliability of the results.

Ethics and dissemination
Ethical approval is not required for this review as it is a secondary study based on public and published data. The findings from this work will be submitted for publication in a peer-reviewed journal and presented at relevant academic conferences. Any amendments to the protocol arising from deviations during the study’s execution will be documented and reported in the final publication.

PROSPERO registration number
CRD42024534272.