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

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.