Risk factors for acute fatigue in patients with stroke: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANG Aiqin ¹ , YU Jintian ² , CHEN Junshan ²

1. Department of Key Clinical Nursing Specialty, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;
2. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern theater General Hospital), Nanjing, 210002, P.R.China;

Corresponding author：

ZHANG Aiqin, Email: aq09z@126.com

Keywords：

Stroke; Post-stroke fatigue; Risk factor; Meta-analysis; Systematic review; Case-control study; Cohort study; Cross-sectional study

DOI：

10.7507/1672-2531.201908081

Video：

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Objectives To systematically review the risk factors of acute fatigue in patients with stroke.Methods PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies, cohort studies and cross-sectional studies on the risk factors of acute fatigue in patients with stroke from inception to April, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 14 studies involving 2 658 objects and 13 risk factors were included. The results of meta-analysis showed that: female (OR=1.54, 95%CI 1.23 to 1.94, P=0.000 2), rural residence (OR=1.46, 95%CI 1.11 to 1.91, P=0.007), diabetes mellitus (OR=1.54, 95%CI 1.24 to 1.92, P<0.000 1), hyperlipidemia (OR=1.41, 95%CI 1.10 to 1.80, P=0.007), coronary heart disease (OR=1.94, 95%CI 1.30 to 2.89, P=0.001), previous stroke history (OR=1.54, 95%CI 1.07 to 2.23, P<0.000 01), pre-stroke fatigue (OR=4.51, 95%CI 3.33 to 6.09, P<0.000 01), basal ganglia stroke (OR=2.76, 95%CI 1.21 to 6.29, P<0.000 01), NIHSS >3 (OR=2.11, 95%CI 1.59 to 2.79, P<0.000 01), admission glucose level (OR=1.08, 95%CI 0.38 to 1.78, P=0.003), post-stroke sleep disorder (OR=2.40, 95%CI 1.87 to 3.07, P<0.000 01), post-stroke pain (OR=2.32, 95%CI 1.56 to 3.45, P<0.000 1) and post-stroke depression (OR=3.31, 95%CI 1.94 to 5.66, P<0.000 1) were risk factors of acute fatigue in patients with stroke.Conclusions Current evidence shows that female, rural residence, diabetes mellitus, hyperlipidemia, coronary heart disease, previous stroke history, pre-stroke fatigue, basal ganglia stroke, NIHSS>3, admission glucose level, post-stroke sleep disorder, post-stroke pain and post-stroke depression are the risk factors of acute fatigue in patients with stroke. Medical staff should strengthen targeted preventive care for high-risk patients with related risk factors in order to reduce the incidence of post-stroke fatigue and improve the clinical prognosis outcome of patients.

Citation： ZHANG Aiqin, YU Jintian, CHEN Junshan. Risk factors for acute fatigue in patients with stroke: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(3): 272-280. doi: 10.7507/1672-2531.201908081 Copy

1.	Naess H, Lunde L, Brogger J, et al. Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study. J Neurol Sci, 2012, 312(1-2): 138-141.
2.	王敏. 缺血性脑卒中患者疲劳发生率及其影响因素研究. 郑州: 郑州大学, 2017.
3.	黄晓敏. 急性期脑卒中后疲劳的影响因素分析及生活质量相关性研究. 贵州: 遵义医科大学, 2019.
4.	Duncan F, Lewis SJ, Greig CA, et al. Exploratory longitudinal cohort study of associations of fatigue after stroke. Stroke, 2015, 46(4): 1052-1058.
5.	Lerdal A, Gay CL. Fatigue in the acute phase after first stroke predicts poorer physical health 18 months later. Neurology, 2013, 81(18): 1581-1587.
6.	Mandliya A, Das A, Unnikrishnan JP, et al. Post-stroke fatigue is an independent predictor of post-stroke disability and burden of care: a path analysis study. Top Stroke Rehabil, 2016, 23(1): 1-7.
7.	Wu S, Mead G, Macleod M, et al. Model of understanding fatigue after stroke. Stroke, 2015, 46(3): 893-898.
8.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses, 2009. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
9.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
10.	Lerdal A, Bakken LN, Rasmussen EF, et al. Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil, 2011, 33(4): 334-342.
11.	Tang WK, Liu XX, Chen YK, et al. Cerebral microbleeds and fatigue in stroke. Eur Neurol, 2014, 71(5-6): 213-216.
12.	陈仰昆, 肖卫民, 袁伟杰, 等. 缺血性脑卒中患者疲劳症状的影响因素分析. 中华物理医学与康复杂志, 2013, 35(8): 640-642.
13.	吴丹, 王林, 滕伟禹, 等. 脑梗死急性期疲劳与血尿酸, 血糖, 抑郁及功能障碍的相关性分析. 中华临床医师杂志(电子版), 2013, 7(23): 10448-10452.
14.	李文辉. 卒中后疲劳风险因素的相关分析. 山东医药, 2014, (25): 36-37.
15.	王珊珊. 缺血性脑卒中患者急性期疲劳发生风险及患病结局研究. 郑州: 河南大学, 2015.
16.	王利, 卞光荣, 马先军, 等. 多量表分析脑卒中后疲劳相关因素及对老年人预后的影响. 中国老年学杂志, 2015, 35(2): 329-330.
17.	谢高生. 急性脑卒中后疲劳的相关因素分析. 沈阳: 中国医科大学, 2016.
18.	乌仁图雅. 通辽地区脑梗死后疲劳情况调查. 呼和浩特: 内蒙古民族大学, 2017.
19.	宋征宇, 王锐. 促甲状腺素与脑卒中后疲劳关系的临床研究. 神经损伤与功能重建, 2017, 12(1): 83-84.
20.	李昱, 彭敏, 余浩佳, 等. 脑梗死后早期疲劳的发生率及其相关危险因素. 医学与哲学(B), 2018, 39(3): 42-45.
21.	赵茂晶. 脑卒中急性期患者卒中后疲劳的调查及下肢运动训练对其疗效的影响. 遵义: 遵义医学院, 2018.
22.	于学涛, 徐海. 老年缺血性脑卒中后疲劳与缺血性脑卒中血清白细胞介素1β、C反应蛋白、同型半胱氨酸水平的相关性分析. 国际检验医学杂志, 2018, 39(13): 1590-1592, 1596.
23.	Hinkle JL, Becker KJ, Kim JS, et al. Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association. Stroke, 2017, 48(7): e159-e170.
24.	Wei C, Zhang F, Chen L, et al. Factors associated with post-stroke depression and fatigue: lesion location and coping styles. J Neurol, 2016, 263(2): 269-276.
25.	Falconer M, Walsh S, Harbison JA. Estimated prevalence of fatigue following stroke and transient ischemic attack is dependent on terminology used and patient gender. J Stroke Cerebrovasc Dis, 2010, 19(6): 431-434.
26.	图克, 何斌斌. 关注1型糖尿病人群的慢性疲劳问题. 糖尿病天地(临床), 2013, 7(11): 516-517.
27.	李珊珊, 袁婧, 吴剑平, 等. 黄芪多糖抗小鼠疲劳的作用机制研究. 现代生物医学进展, 2014, 14(36): 7052-7055.
28.	Kutlubaev MA, Shenkin SD, Farrall AJ, et al. CT and clinical predictors of fatigue at one month after stroke. Cerebrovasc Dis Extra, 2013, 3(1): 26-34.
29.	Scott JF, Robinson GM, French JM, et al. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet, 1999, 353(9150): 376-377.
30.	Ormstad H, Aass HC, Amthor KF, et al. Serum levels of cytokines, glucose, and hemoglobin as possible predictors of poststroke depression, and association with poststroke fatigue. Int J Neurosci, 2012, 122(11): 682-690.
31.	Aaronson JA, van Bennekom CA, Hofman WF, et al. Obstructive sleep apnea is related to impaired cognitive and functional status after stroke. Sleep, 2015, 38(9): 1431-1437.
32.	Bakken LN, Lee KA, Kim HS, et al. Sleep-wake patterns during the acute phase after first-ever stroke. Stroke Res Treat, 2011, 2011: 936298.
33.	Duncan F, Wu S, Mead GE. Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies. J Psychosom Res, 2012, 73(1): 18-27.

1. Naess H, Lunde L, Brogger J, et al. Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study. J Neurol Sci, 2012, 312(1-2): 138-141.
2. 王敏. 缺血性脑卒中患者疲劳发生率及其影响因素研究. 郑州: 郑州大学, 2017.
3. 黄晓敏. 急性期脑卒中后疲劳的影响因素分析及生活质量相关性研究. 贵州: 遵义医科大学, 2019.
4. Duncan F, Lewis SJ, Greig CA, et al. Exploratory longitudinal cohort study of associations of fatigue after stroke. Stroke, 2015, 46(4): 1052-1058.
5. Lerdal A, Gay CL. Fatigue in the acute phase after first stroke predicts poorer physical health 18 months later. Neurology, 2013, 81(18): 1581-1587.
6. Mandliya A, Das A, Unnikrishnan JP, et al. Post-stroke fatigue is an independent predictor of post-stroke disability and burden of care: a path analysis study. Top Stroke Rehabil, 2016, 23(1): 1-7.
7. Wu S, Mead G, Macleod M, et al. Model of understanding fatigue after stroke. Stroke, 2015, 46(3): 893-898.
8. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses, 2009. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
9. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
10. Lerdal A, Bakken LN, Rasmussen EF, et al. Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil, 2011, 33(4): 334-342.
11. Tang WK, Liu XX, Chen YK, et al. Cerebral microbleeds and fatigue in stroke. Eur Neurol, 2014, 71(5-6): 213-216.
12. 陈仰昆, 肖卫民, 袁伟杰, 等. 缺血性脑卒中患者疲劳症状的影响因素分析. 中华物理医学与康复杂志, 2013, 35(8): 640-642.
13. 吴丹, 王林, 滕伟禹, 等. 脑梗死急性期疲劳与血尿酸, 血糖, 抑郁及功能障碍的相关性分析. 中华临床医师杂志(电子版), 2013, 7(23): 10448-10452.
14. 李文辉. 卒中后疲劳风险因素的相关分析. 山东医药, 2014, (25): 36-37.
15. 王珊珊. 缺血性脑卒中患者急性期疲劳发生风险及患病结局研究. 郑州: 河南大学, 2015.
16. 王利, 卞光荣, 马先军, 等. 多量表分析脑卒中后疲劳相关因素及对老年人预后的影响. 中国老年学杂志, 2015, 35(2): 329-330.
17. 谢高生. 急性脑卒中后疲劳的相关因素分析. 沈阳: 中国医科大学, 2016.
18. 乌仁图雅. 通辽地区脑梗死后疲劳情况调查. 呼和浩特: 内蒙古民族大学, 2017.
19. 宋征宇, 王锐. 促甲状腺素与脑卒中后疲劳关系的临床研究. 神经损伤与功能重建, 2017, 12(1): 83-84.
20. 李昱, 彭敏, 余浩佳, 等. 脑梗死后早期疲劳的发生率及其相关危险因素. 医学与哲学(B), 2018, 39(3): 42-45.
21. 赵茂晶. 脑卒中急性期患者卒中后疲劳的调查及下肢运动训练对其疗效的影响. 遵义: 遵义医学院, 2018.
22. 于学涛, 徐海. 老年缺血性脑卒中后疲劳与缺血性脑卒中血清白细胞介素1β、C反应蛋白、同型半胱氨酸水平的相关性分析. 国际检验医学杂志, 2018, 39(13): 1590-1592, 1596.
23. Hinkle JL, Becker KJ, Kim JS, et al. Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association. Stroke, 2017, 48(7): e159-e170.
24. Wei C, Zhang F, Chen L, et al. Factors associated with post-stroke depression and fatigue: lesion location and coping styles. J Neurol, 2016, 263(2): 269-276.
25. Falconer M, Walsh S, Harbison JA. Estimated prevalence of fatigue following stroke and transient ischemic attack is dependent on terminology used and patient gender. J Stroke Cerebrovasc Dis, 2010, 19(6): 431-434.
26. 图克, 何斌斌. 关注1型糖尿病人群的慢性疲劳问题. 糖尿病天地(临床), 2013, 7(11): 516-517.
27. 李珊珊, 袁婧, 吴剑平, 等. 黄芪多糖抗小鼠疲劳的作用机制研究. 现代生物医学进展, 2014, 14(36): 7052-7055.
28. Kutlubaev MA, Shenkin SD, Farrall AJ, et al. CT and clinical predictors of fatigue at one month after stroke. Cerebrovasc Dis Extra, 2013, 3(1): 26-34.
29. Scott JF, Robinson GM, French JM, et al. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet, 1999, 353(9150): 376-377.
30. Ormstad H, Aass HC, Amthor KF, et al. Serum levels of cytokines, glucose, and hemoglobin as possible predictors of poststroke depression, and association with poststroke fatigue. Int J Neurosci, 2012, 122(11): 682-690.
31. Aaronson JA, van Bennekom CA, Hofman WF, et al. Obstructive sleep apnea is related to impaired cognitive and functional status after stroke. Sleep, 2015, 38(9): 1431-1437.
32. Bakken LN, Lee KA, Kim HS, et al. Sleep-wake patterns during the acute phase after first-ever stroke. Stroke Res Treat, 2011, 2011: 936298.
33. Duncan F, Wu S, Mead GE. Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies. J Psychosom Res, 2012, 73(1): 18-27.

Chinese Journal of Evidence-Based Medicine

Risk factors for acute fatigue in patients with stroke: a meta-analysis

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