Predictor Of Poststroke Fatigue Research Articles

Analysis of Factors Affecting Post-Stroke Fatigue: An Observational, Cross-Sectional, Retrospective Chart Review Study.

Post-stroke fatigue (PSF) is one of the most common emotional and mood disorders in stroke survivors. Several studies have suggested associations between PSF and various factors. However, they describe conflicting results. Therefore, this study aimed to evaluate the factors affecting PSF. We retrospectively reviewed the medical records of 178 hospitalized stroke patients. The collected data were compared between the PSF and control groups. To evaluate the association between factors and PSF, regression analysis was conducted. A total of 96 patients (53.9%) were assigned to the PSF group, and 82 patients were assigned to the control group. Age, neurological deficits, cognitive dysfunction, degree of depression, hs-CRP, and ESR differed significantly between the two groups. For both types of stroke, multiple linear regression analyses showed that degree of depression and degree of inflammation were significantly associated with PSF. Through subgroup analysis, multiple linear regression analyses showed that the degree of depression in ischemic and hemorrhagic stroke and the platelet-to-lymphocyte ratio in hemorrhagic stroke had a significant association with PSF. In conclusion, post-stroke depression and degree of inflammation could be clinically significant predictors of PSF in all types of stroke patients. However, larger, prospective studies are required to obtain more concrete results.

Editors' note: Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke

In the article “Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke”, Wang et al. found that serum levels of thyroid stimulating hormone were inversely associated with risk and severity of poststroke fatigue (PSF) in 704 consecutive patients with ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF. In response, Dr. Bunevicius notes that thyroid hormone concentrations fluctuate in the acute phase of stroke, making it difficult to estimate whether single-point thyroid-related measurements reflect prior or new hormonal balance or an acute response, and provides examples of medications and interventions that may interfere with thyroid gland functioning in the acute stroke setting. Dr. Bunevicius also suggests examining the relationship of the triiodothyronine to thyroxin ratio and PFS severity. The authors did not respond to these comments. In the article “Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke”, Wang et al. found that serum levels of thyroid stimulating hormone were inversely associated with risk and severity of poststroke fatigue (PSF) in 704 consecutive patients with ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.

Reader response: Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke.

Wang et al.1 reported that in patients with acute ischemic stroke, lower concentrations of thyroid-stimulating hormone were associated with greater fatigue symptom severity in acute phase and at follow-up. The article contributes to the growing body of literature underscoring the importance of thyroid axis function for clinical and patient-centered outcomes of cerebrovascular disorders.2

Prevalence, Trajectory, and Predictors of Poststroke Fatigue among Ghanaians

Background and PurposePoststroke fatigue (PSF) is rife among stroke survivors and it exerts a detrimental toll on recovery from functional deficits. The burden of PSF is unknown in sub-Saharan Africa. We have assessed the prevalence, trajectory, and predictors of PSF among 60 recent Ghanaian stroke patients. MethodsStudy participants in this prospective cohort (recruited between January 2017 and June 2017) were stroke survivors, aged greater than 18 years, with CT scan confirmed stroke of less than 1-month onset. PSF was assessed using the Fatigue Severity Scale (FSS) at enrollment, months 3, 6, and 9. Those with a score of greater than or equal to 4 points on FSS were categorized as “fatigued.” A multivariate logistic regression analysis was performed to identify independent predictors of PSF at enrollment and at month 9. ResultsSixty-five percent (65%) of our sample were males with a mean age of 55.1 ± 12.7 years. In addition to all participants having hypertension, 85% had dyslipidemia and 25% had diabetes mellitus. Ischemic strokes comprised 76.6% of the study population. The prevalence of PSF was 58.9% at baseline and declined to 23.6% at month 9, P = .0002. Diabetes mellitus was significantly associated with PSF at baseline with an adjusted odds ratio of 15.12 (95% CI: 1.70-134.30), P = .01. However, at month 9, age greater than or equal to 65 years, adjusted odds ratio (aOR) of 7.02 (95% CI: 1.16-42.52); female sex, aOR of 8.52 (1.23-59.16), and depression, aOR of 8.86 (1.19-65.88) were independently associated with PSF. ConclusionsApproximately 6 out of 10 Ghanaian stroke survivors experience PSF within the first month of stroke onset. PSF persists in approximately 1 out of 4 stroke survivors at 10 months after the index stroke. Further studies to elucidate the underlying mechanisms for PSF are required and adequately powered interventional multicenter trials are eagerly awaited to provide solid evidence base for the clinical management of PSF.

Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke.

To investigate whether thyroid function profiles can predict poststroke fatigue (PSF) in patients with acute ischemic stroke. Patients with stroke were consecutively recruited within 3 days of onset in Jinling Hospital. Serum levels of thyroid hormones, thyroid antibodies, hematologic indexes, and biochemical indexes were measured on admission. Fatigue was scored using the Fatigue Severity Scale. Associations were analyzed with multivariate regression and restricted cubic splines. Of the 704 patients with stroke, 292 (41.5%) were diagnosed with fatigue in the acute stage and 224 (35.3%) 6 months after the index stroke. The serum levels of thyroid-stimulating hormone (TSH) were inversely associated with the risk of PSF in both the acute phase and at follow-up evaluations after adjusting for potential confounders (odds ratio 0.30, 95% confidence interval 0.24-0.37 in the acute phase, and odds ratio 0.70, 95% confidence interval 0.58-0.84 at follow-up). The subgroup analysis indicated that in the acute phase of ischemic stroke, TSH was associated with severity of PSF in the groups with euthyroidism (β = -0.70, p < 0.001), subclinical hypothyroidism (β = -0.44, p < 0.001), and low-T3 syndrome (β = -0.34, p = 0.008). Higher TSH was associated with better Fatigue Severity Scale scores in patients with low-T3 syndrome 6 months after the index stroke (β = -0.35, p = 0.01). Furthermore, in the group with low-T3 syndrome, FT3 serum level could also indicate a higher risk of PSF (β = -2.54, p < 0.001 in the acute phase, and β = -2.67, p < 0.001 at follow-up). Thyroid function profiles may predict fatigue after acute ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.

Erratum to: Serum cytokine and glucose levels as predictors of poststroke fatigue in acute ischemic stroke patients

Erratum to: Serum cytokine and glucose levels as predictors of poststroke fatigue in acute ischemic stroke patients

Serum cytokine and glucose levels as predictors of poststroke fatigue in acute ischemic stroke patients

Fatigue is a common but often overlooked symptom after stroke. This study investigated whether stroke type, infarct volume, and laterality, as well as the levels of various cytokines and other blood components in the acute phase of acute ischemic stroke (AIS), can predict the level of fatigue at 6, 12, and 18 months after its onset. In 45 patients with acute stroke, serum levels of C-reactive protein, hemoglobin, glucose, and 13 cytokines were measured within 72 h of stroke onset. The cytokine measurements were performed using BioPlex XMap technology (Luminex). The acute serum levels of interleukin (IL)-1β and glucose were positively correlated with the score on the Fatigue Severity Scale (FSS) at 6 months after the stroke (r = 0.37, p = 0.015, and r = 0.37, p = 0.017, respectively). The acute serum levels of IL-ra and IL-9 were negatively correlated with FSS score at 12 months after the stroke (r = −0.38, p = 0.013, and r = −0.36, p = 0.019, respectively). The FSS score at 12 months after stroke was significantly lower in patients with radiologically confirmed infarction than in those without such confirmation (p = 0.048). The FSS score at 18 months was not correlated with any of the measured variables. High acute serum levels of glucose and IL-1β, and low IL1-ra and IL-9 may predict fatigue after AIS, indicating that the development of poststroke fatigue can be accounted for by the proinflammatory response associated with AIS. These novel findings support a new cytokine theory of fatigue after stroke. However, more research is needed to validate the results of this study.