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Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis

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Abstract

Background

Post-stroke fatigue (PSF) is one of the most common complications of stroke and has a negative impact on quality of life over time. Although several therapeutic approaches have been explored in the last decade, the risk factors responsible for the occurrence of PSF are still largely unknown.

Objective

The aim of this meta-analysis was to identify the risk factors contributing to PSF, especially clinical and social risk factors, which may help to prevent PSF.

Methods

A systematic literature search was performed with PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception until April 2019. Only original studies measuring the association between potential risk factors and PSF were included. All relevant data the included studies were extracted by two independent reviewers using predefined data fields.

Results

Fourteen studies (n = 3933) were included in this meta-analysis. Female (OR = 1.39; p < 0.01), thalamus (OR = 1.76; p = 0.02), leucoaraiosis (OR = 1.73; p < 0.01), NIHSS score (OR = 1.16; p < 0.01), modified Rankin Scale (OR = 1.63; p < 0.01), depression (OR = 1.75; p < 0.01), and sleeping disturbances (OR = 2.01; p < 0.01) were all significantly associated with PSF. In the subgroup analysis, depression (OR = 2.75; p < 0.01) tended to be associated with Asian patients with PSF. For patients who had a stroke survive for more than half a year, PSF was more likely to occur in stroke survivors with depression (OR = 1.46; p < 0.01), anxiety (OR = 1.13; p < 0.01), or sleeping disturbances (OR = 1.98; p < 0.01).

Conclusion

Despite some limitations, this study first identified that female and depression conferred an increased susceptibility to PSF, regardless of whether in European or Asian populations. Risk factors associated with PSF included female, thalamic, leucoaraiosis, depression, sleeping disturbances, diabetes mellitus, and anxiety. This meta-analysis shows that chronic PSF appears to be largely attributable to patients with multiple comorbidities. It is necessary to strengthen the treatment for stroke-related complications and improve stroke patient care, which could help to reduce the incidence of PSF.

Trial registration

CRD42019128751

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Acknowledgments

We thank Xiangfei Li for helping to review the full-text articles for eligibility.

Funding

This work was supported by the Zhuweifeng Guangdong Provincial Famous Chinese Medicine Studio Construction Project (Guangdong Chinese Medicine Office 2018(5)), 2020 Major Project of Science and Technology Project of Guangdong Province Traditional Chinese Medicine Bureau (20203015), and Science and technology development plan of Shandong Province (2017G006021).

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Author notes

  1. Shuangmei Zhang and Sijia Cheng contributed equally to this work.

Authors and Affiliations

  1. Department of Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China

    Shuangmei Zhang

  2. Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510145, China

    Shuangmei Zhang, Sijia Cheng & Anrong Wang

  3. Science and Technology Innovation Center Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510145, China

    Sijia Cheng & Anrong Wang

  4. Department of Neurology, Peking University People’s Hospital, Beijing, 100044, China

    Zhaoxu Zhang

  5. Department of Neurology, Chinese Medicine Hospital Affiliated to Guangzhou Medical University, Guangzhou, 510145, China

    Chengyin Wang & Weifeng Zhu

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  1. Shuangmei Zhang
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Correspondence to Weifeng Zhu.

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Zhang, S., Cheng, S., Zhang, Z. et al. Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis. Neurol Sci 42, 1463–1471 (2021). https://doi.org/10.1007/s10072-020-04633-w

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