Abstract
Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. There was no significant difference in age-standardised and sex-standardised mortality ratios (SMRs) for all-cause mortality (SMR 1·14, 95% CI 0·65-1·85; p=0·67) or cancer-specific mortality (1·39, 0·60-2·73; p=0·45) in patients with chronic fatigue syndrome when compared with the general population in England and Wales. This remained the case when deaths from suicide were removed from the analysis. There was a significant increase in suicide-specific mortality (SMR 6·85, 95% CI 2·22-15·98; p=0·002). We did not note increased all-cause mortality in people with chronic fatigue syndrome, but our findings show a substantial increase in mortality from suicide. This highlights the need for clinicians to be aware of the increased risk of completed suicide and to assess suicidality adequately in patients with chronic fatigue syndrome. National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
Highlights
Chronic fatigue syndrome is an illness characterised by persistent or relapsing fatigue of a debilitating nature, which is present for at least 6 months, in addition to at least four symptoms from a range including memory loss, poor concentration, joint pain, and tender glands.[1,2] Patients with chronic fatigue syndrome usually have extensive investigations to ensure any potential treatable medical causes of fatigue are addressed
Claims have been made on the basis of small, uncontrolled, clinical case series of higher overall death risks for heart failure, cancer, and suicide in people with chronic fatigue syndrome,[4,5] a review of descriptive studies that reported follow-up or outcome data from patients with a primary diagnosis of chronic fatigue syndrome showed no convincing evidence of increased all-cause mortality or suicide-specific mortality.[6]
The results suggested no increased all-cause or suicide-specific mortality in 641 individuals with chronic fatigue syndrome; the study was limited by its small sample size, with both all-cause and suicide-specific mortality outcomes receiving a GRADE rating of very low quality evidence
Summary
Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register.
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