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. 缺血性腦卒中患者疲勞發生率及其影響因素研究. 鄭州: 鄭州大學, 2017.
3.	黃曉敏. 急性期腦卒中后疲勞的影響因素分析及生活質量相關性研究. 貴州: 遵義醫科大學, 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.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 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.	陳仰昆, 肖衛民, 袁偉杰, 等. 缺血性腦卒中患者疲勞癥狀的影響因素分析. 中華物理醫學與康復雜志, 2013, 35(8): 640-642.
13.	吳丹, 王林, 滕偉禹, 等. 腦梗死急性期疲勞與血尿酸, 血糖, 抑郁及功能障礙的相關性分析. 中華臨床醫師雜志(電子版), 2013, 7(23): 10448-10452.
14.	李文輝. 卒中后疲勞風險因素的相關分析. 山東醫藥, 2014, (25): 36-37.
15.	王珊珊. 缺血性腦卒中患者急性期疲勞發生風險及患病結局研究. 鄭州: 河南大學, 2015.
16.	王利, 卞光榮, 馬先軍, 等. 多量表分析腦卒中后疲勞相關因素及對老年人預后的影響. 中國老年學雜志, 2015, 35(2): 329-330.
17.	謝高生. 急性腦卒中后疲勞的相關因素分析. 沈陽: 中國醫科大學, 2016.
18.	烏仁圖雅. 通遼地區腦梗死后疲勞情況調查. 呼和浩特: 內蒙古民族大學, 2017.
19.	宋征宇, 王銳. 促甲狀腺素與腦卒中后疲勞關系的臨床研究. 神經損傷與功能重建, 2017, 12(1): 83-84.
20.	李昱, 彭敏, 余浩佳, 等. 腦梗死后早期疲勞的發生率及其相關危險因素. 醫學與哲學(B), 2018, 39(3): 42-45.
21.	趙茂晶. 腦卒中急性期患者卒中后疲勞的調查及下肢運動訓練對其療效的影響. 遵義: 遵義醫學院, 2018.
22.	于學濤, 徐海. 老年缺血性腦卒中后疲勞與缺血性腦卒中血清白細胞介素1β、C反應蛋白、同型半胱氨酸水平的相關性分析. 國際檢驗醫學雜志, 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.	圖克, 何斌斌. 關注1型糖尿病人群的慢性疲勞問題. 糖尿病天地(臨床), 2013, 7(11): 516-517.
27.	李珊珊, 袁婧, 吳劍平, 等. 黃芪多糖抗小鼠疲勞的作用機制研究. 現代生物醫學進展, 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. 缺血性腦卒中患者疲勞發生率及其影響因素研究. 鄭州: 鄭州大學, 2017.
3. 黃曉敏. 急性期腦卒中后疲勞的影響因素分析及生活質量相關性研究. 貴州: 遵義醫科大學, 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. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 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. 陳仰昆, 肖衛民, 袁偉杰, 等. 缺血性腦卒中患者疲勞癥狀的影響因素分析. 中華物理醫學與康復雜志, 2013, 35(8): 640-642.
13. 吳丹, 王林, 滕偉禹, 等. 腦梗死急性期疲勞與血尿酸, 血糖, 抑郁及功能障礙的相關性分析. 中華臨床醫師雜志(電子版), 2013, 7(23): 10448-10452.
14. 李文輝. 卒中后疲勞風險因素的相關分析. 山東醫藥, 2014, (25): 36-37.
15. 王珊珊. 缺血性腦卒中患者急性期疲勞發生風險及患病結局研究. 鄭州: 河南大學, 2015.
16. 王利, 卞光榮, 馬先軍, 等. 多量表分析腦卒中后疲勞相關因素及對老年人預后的影響. 中國老年學雜志, 2015, 35(2): 329-330.
17. 謝高生. 急性腦卒中后疲勞的相關因素分析. 沈陽: 中國醫科大學, 2016.
18. 烏仁圖雅. 通遼地區腦梗死后疲勞情況調查. 呼和浩特: 內蒙古民族大學, 2017.
19. 宋征宇, 王銳. 促甲狀腺素與腦卒中后疲勞關系的臨床研究. 神經損傷與功能重建, 2017, 12(1): 83-84.
20. 李昱, 彭敏, 余浩佳, 等. 腦梗死后早期疲勞的發生率及其相關危險因素. 醫學與哲學(B), 2018, 39(3): 42-45.
21. 趙茂晶. 腦卒中急性期患者卒中后疲勞的調查及下肢運動訓練對其療效的影響. 遵義: 遵義醫學院, 2018.
22. 于學濤, 徐海. 老年缺血性腦卒中后疲勞與缺血性腦卒中血清白細胞介素1β、C反應蛋白、同型半胱氨酸水平的相關性分析. 國際檢驗醫學雜志, 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. 圖克, 何斌斌. 關注1型糖尿病人群的慢性疲勞問題. 糖尿病天地(臨床), 2013, 7(11): 516-517.
27. 李珊珊, 袁婧, 吳劍平, 等. 黃芪多糖抗小鼠疲勞的作用機制研究. 現代生物醫學進展, 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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