***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Asymptomatic hemorrhagic transformation of infa rct ion ( AHTI ) is common , but its risk factors and relationship with functional outcome are poorly defined . Methods — The analyses used data from the Tinzapararin in Acute Ischaemic Stroke Trial , a r and omized controlled trial assessing tinzaparin ( low molecular weight heparin ) versus aspirin in 1484 patients with acute ischemic stroke . CT head scans ( baseline , day 10 ) were adjudicated for the presence of hemorrhagic transformation . Stroke subtype was classified according to modified Trial of Org 10172 in Acute Stroke Treatment ( small vessel , large vessel , cardioembolic ) and the Oxfordshire Community Stroke Project ( total anterior , partial anterior , lacunar , and posterior circulatory syndromes ) . Modified Rankin scale and Barthel Index were measured at 3 and 6 months . Analyses were adjusted for age , sex , severity , blood pressure , infa rct volume , and treatment . Symptomatic hemorrhage was excluded . Results — At day 10 , AHTI did not differ between aspirin ( 300 mg ; 32.8 % ) and medium-dose ( 100 IU/kg ; 36.0 % ) and high-dose ( 175 IU/kg ; 31.4 % ) tinzaparin groups ( P=0.44 ) . Relative to lacunar stroke , AHTI on follow-up CT was significantly increased in total anterior circulation syndrome ( odds ratio , 11.5 ; 95 % CI , 7.1 to 18.7 ) and partial anterior circulation syndrome ( odds ratio , 7.2 ; 95 % CI , 4.5 to 11.4 ) stroke . Similarly , relative to small vessel disease , AHTI was increased in large vessel ( odds ratio , 15.1 ; 95 % CI , 9.4 to 24.3 ) and cardioembolic ( odds ratio , 14.1 ; 95 % CI , 8.5 to 23.5 ) stroke . After adjustment for infa rct volume , the presence of AHTI was not associated with outcome at 3 or 6 months as measured by the modified Rankin Scale and Barthel Index . Conclusions — AHTI is increased in ischemic stroke with cortical syndromes and of large vessel or cardioembolic etiology . Heparin does not increase AHTI . AHTI is not associated with functional outcome BACKGROUND Urinary tract infection ( UTI ) is a recognized complication of stroke . We aim ed to determine the incidence of UTI after acute stroke , the risk factors associated with this complication , and its association with outcome . METHODS Prospect i ve study of consecutive acute stroke patients admitted to an urban teaching hospital . Routine clinical assessment included the modified National Institutes of Health Stroke Scale ( mNIHSS ) and modified Rankin scale ( mRS ) . Patients were followed up for 3 months , including recording of clinician diagnosis of UTI . RESULTS We studied 412 patients ; 65 ( 15.8 % ) were diagnosed with UTI , at a median of 14 days ( IQR = 4 - 39 ) post-stroke . In a binomial multivariate regression analysis , UTI was associated with urinary catheterization ( OR = 3.03 , 95 % CI 1.41 - 6.52 ) , higher mRS ( OR = 1.85 , 1.29 - 2.64 ) and increasing age ( OR = 1.51 , 1.13 - 2.00 for each decade ) . UTI was associated with death or disability at 3 months , however , this link was attenuated and became non-significant when measures of stroke severity and pre-stroke morbidity were included in a multivariate analysis . CONCLUSION UTI is common after acute stroke . It is associated with urinary catheterization , post-stroke disability and increasing age . Avoidance of catheterization might reduce the incidence of this common complication We sought to establish the pattern of blood pressure ( BP ) change after hospitalization for acute hemispheric stroke . Methods In 292 patients from the Leicester teaching hospitals with acute hemispheric stroke within the previous 24 hours ( 139 men ; median age , 75 years [ range , 42 to 98 years ] ) , we prospect ively studied BP changes between admission , 24 hours , 1 week , and 4 to 6 weeks . Changes were assessed in relation to the main stroke risk factors , stroke type and severity , and antihypertensive drug treatment . All subjects were followed up for 1 week , with 117 subjects followed up for 4 to 6 weeks . Changes were assessed by repeated- measures ANOVA , and Student 's t tests were used to compare group pairs . Results Systolic and diastolic BP fell by 12 mm Hg ( 95 % confidence interval [ CI ] , 8 to 15 mm Hg ) and 7 mm Hg ( 95 % CI , 5 to 9 mm Hg ) , respectively , in the first 24 hours and 22 mm Hg ( 95 % CI , 18 to 25 mm Hg ) and 12 mm Hg ( 95 % CI , 10 to 14 mm Hg ) , respectively , during the first week ( all changes significant at P<.01 ) but no further thereafter . In those patients receiving no antihypertensive medication before or after stroke , the pattern of change was similar to that of the whole group . Previously diagnosed hypertensive subjects ( n=106 ) had higher initial BP values than did normotensive subjects , although by 1 week the levels were not significantly different . Patients with cerebral hemorrhage confirmed by computed tomography ( n=20 ) had higher systolic BP , but not diastolic BP , throughout the first week than those with cerebral infa rct ion ( n=89 ) . The severity of stroke , age , and previous stroke history did not appear to alter the BP pattern . Stroke patients who were moderate to heavy alcohol consumers had lower convalescent systolic BP levels than lighter drinkers or abstainers . Conclusions We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric stroke , with little change thereafter . Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those with cerebral infa rct . Moderate to heavy alcohol consumption before stroke was associated with a greater systolic BP decline in the first week after the event compared with stroke patients who were light drinkers or abstainers BACKGROUND AND PURPOSE Even patients with the most severe strokes sometimes experience a remarkably good recovery . We evaluated possible predictors of a good outcome to search for new therapeutic strategies . METHODS We included the 223 patients ( 19 % ) with the most severe strokes ( Sc and inavian Stroke Scale score < 15 points ) from the 1197 unselected patients in the Copenhagen Stroke Study . Of these , 139 ( 62 % ) died in the hospital and were excluded . The 26 survivors ( 31 % ) with a good functional outcome ( Barthel Index > /=50 points ) were compared with the 58 survivors ( 69 % ) with a poor functional outcome ( Barthel Index < 50 points ) . The predictive value of the following factors was examined in a multivariate logistic regression model : age ; sex ; a spouse ; work ; home care before stroke ; initial stroke severity ; blood pressure , blood glucose , and body temperature on admission ; stroke subtype ; neurological impairment 1 week after onset ; diabetes ; hypertension ; atrial fibrillation ; ischemic heart disease ; previous stroke ; and other disabling disease . RESULTS Decreasing age ( odds ratio [ OR ] , 0.50 per 10-year decrease ; 95 % CI , 0.25 to 0.99 ; P=0.04 ) , a spouse ( OR , 3.1 ; 95 % CI , 1.1 to 8 . 8 ; P=0.03 ) , decreasing body temperature on admission ( OR , 1.8 per 1 degrees C decrease ; 95 % CI , 1.1 to 3.1 ; P=0.01 ) , and neurological recovery after 1 week ( OR , 3.2 per 10-point increase in Sc and inavian Stroke Scale score ; 95 % CI , 1.1 to 7.8 ; P=0.01 ) were all independent predictors of good functional outcome . CONCLUSIONS Patients with the most severe strokes who achieve a good functional outcome  are generally characterized by younger age , the presence of a spouse at home , and early neurological recovery . Body temperature was a strong predictor of good functional outcome and the only potentially modifiable factor . We suggest that a r and omized controlled trial be undertaken to evaluate whether active reduction of body temperature can improve the generally poor prognosis of patients with the most severe strokes BACKGROUND AND PURPOSE The great variability of outcome seen in stroke patients has led to an interest in identifying predictors of outcome . The combination of clinical and imaging variables as predictors of stroke outcome in a multivariable risk adjustment model may be more powerful than either alone . The purpose of this study was to determine the multivariable relationship between infa rct volume , 6 clinical variables , and 3-month outcomes in ischemic stroke patients . METHODS Included in the study were 256 eligible patients from the R and omized Trial of Tirilazad Mesylate in Acute Stroke ( RANTTAS ) . Six clinical variables and 1-week infa rct volume were the prespecified predictor variables . The National Institutes of Health Stroke Scale , Barthel Index , and Glasgow Outcome Scale were the outcomes . Multivariable logistic regression techniques were used to develop the model equations , and bootstrap techniques were used for internal validation . Predictive performance of the models was assessed for discrimination with receiver operator characteristic ( ROC ) curves and for calibration with calibration curves . RESULTS The predictive models had areas under the ROC curve of 0.79 to 0.88 and demonstrated nearly ideal calibration curves . The areas under the ROC curves were statistically greater ( P<0.001 ) with both clinical and imaging information combined than with either alone for predicting excellent recovery and death or severe disability . CONCLUSIONS Combined clinical and imaging variables are predictive of 3-month outcome in ischemic stroke patients . Demonstration of this relationship with acute clinical variables and 1-week infa rct information supports future attempts to predict 3-month outcome with all acute variables Objective : To ” nd patient characteristics in the early post stroke phase that could predict three years functional outcome . Design : Prospect i ve study . Setting : In-hospital rehabilitation department ( admission and discharge ) . Outpatient department one and three years post stroke . Subjects : One hundred and forty-two stroke patients ( 56 % women ) , median age 75 years . Main outcome measures : Barthel Index ( BI ) score ; BI score change ; accommodation status ; Rankin scale score ; and Frenchay Activities Index ( FAI ) score , all registered three years post stroke . Results : The percentages of patients still living at home after one and three years were 88 % and 83 % , respectively . Twenty per cent of the patients had deteriorated according to the BI after three years , mostly due to recurrent strokes ( odds ratio ( OR ) 10.3 ; 95 % con”dence interval ( CI ) 3.0–35.5 ) and co-morbidity with other disabling disorders ( OR 3.9 ; CI 1.1–13.5 ) . Co-morbidity also emerged as an important risk factor for dependency according to BI score ( OR 8.8 ; CI 2.4–32.1 ) as well as for a poor FAI score ( OR 4.9 ; CI 1.9–13.0 ) . BI in the early phase was the strongest predictor for long-term functional outcome . Urinary incontinence emerged as a risk factor for nursing home placement after three years ( OR 3.2 ; CI 0.9–11.3 ) . Cognitive dysfunction was a risk factor for poor FAI scoring ( OR 2.7 ; CI 1.0–7.0 ) . Conclusions : After stroke rehabilitation , concomitant chronic disabling disorders and recurrent strokes seem to play an important role regarding dependency , h and icap and long-term functional decline The third most common stroke complication is infection . We studied the rates of aspiration pneumonia and urinary tract infection ( UTI ) , their risk factors and their effect on outcome in the  1455 Glycine Antagonist ( Gavestinel ) in Neuroprotection ( GAIN ) International patients with ischaemic stroke . Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7 , after correcting for prognostic factors . Higher baseline National Institute of Health Stroke Scale ( NIHSS ) and age , male gender , history of diabetes and stroke subtype predicted pneumonia , which occurred in 13.6 % of patients . Female gender and higher baseline NIHSS and age predicted UTI , which occurred in 17.2 % of patients . Pneumonia was associated with poor outcome by mortality ( hazard ratio , 2.2 ; 95 % confidence interval , 1.5 - 3.3 ) , Barthel index ( < 60 ) ( odds ratio , 3.8 ; 2.2 - 6.7 ) , NIHSS ( 4.9 ; 1.7 - 14 ) and Rankin scale ( > /=2 ) ( 3.4 ; 1.4 - 8.3 ) . UTI was associated with Barthel index ( 1.9 ; 1.2 - 2.9 ) , NI 
    Output:
    
There are rather consistent findings that greater age , a more severe stroke ( measured through a clinical evaluation scale ) , the presence of urinary incontinence ( with impaired awareness ) and a larger stroke volume ( measured through brain imaging techniques ) predict poor stroke outcome .
Studies using a selected group of stroke patients tended to identify different predictors .
The current evidence is insufficient for the development of a clinical prediction tool that is better than physicians ' informal predictions .