Potential Risk Factors Of Post-stroke Fatigue

Objective: To assess fatigue 3 months after acute ischemic stroke(AIS).The risk factors related to post-stroke fatigue(PSF)were discussed.And the predictive value of clinical characteristics and peripheral blood indicators in acute stage after cerebral ischemia for the occurrence of PSF were evaluated.Methods: Patients with first-episode AIS were admitted to the Department of Neurology,Zhongda Hospital affiliated to Southeast University from March 2021 to December 2021 according to inclusion and exclusion criteria.Clinical baseline information,peripheral blood neutrophil count(N),neutrophil ratio(N%),lymphocyte count(L),lymphocyte ratio(L%)、neutrophil to lymphocyte ratio(NLR)、cytokines(IL-1β、IL-6、IL-8)、blood lipids,thyroid hormones level and imaging data of brain were collected within 72 hours of onset.The patients included were followed up by clinic follow-up/telephone 3 months after AIS.Fatigue state of included patients was assessed using the Fatigue Scale for Motor and Cognitive Functions(FSMC).The relationship between the clinical characteristics and peripheral blood indicators of included patients and fatigue rating score were analyzed.Factors related to fatigue were screened by univariate analysis.And the predictive value of the screened variables for PSF was further verified by Logistic regression.Receiver operator characteristic curve(ROC Curve)was used to analyze the prediction efficiency of univariate and multivariable prediction models for PSF occurrence 3 months after AIS onset.Results: A total of 168 first-episode AIS patients(124 males,mean age 64.9 years)who met the inclusion criteria were included in this study.A total of 66 patients(39.3%)showed fatigue symptoms.Univariate analysis showed that the differences of peripheral blood N,N %,L%,NLR,HS-CRP,IL-1β and TSH level between fatigue/non-fatigue group were statistically significant(P<0.05).Rank correlation analysis showed that N%,NLR and HS-CRP level in acute stage of ischemic stroke were positively correlated with FSMC score 3 months after onset(P<0.05),while L% and TSH level were negatively correlated with FSMC score 3months after onset(P<0.05).ROC analysis showed that TSH/HS-CRP/IL-1β combined with N%,L% or NLR respectively could improve the predictive value of peripheral blood indicators for PSF,among which TSH/ HS-CRP /IL-1β combined with NLR had the best predictive value for fatigue occurrence 3 months after AIS.Area under the curve(AUC)increased from 0.640 to 0.737(P<0.01).Conclusions: PSF was prevalent 3 months after onset of AIS.The level of N%,L%,NLR,IL-1β,HS-CRP and TSH in peripheral blood were correlated with the occurrence of fatigue 3months after AIS onset.TSH/ HS-CRP /IL-1β combine N%,L% or NLR level in peripheral blood can improve the predictive value of fatigue 3 months after AIS onset,among which TSH/ HS-CRP /IL-1β combined with NLR has the highest predictive value.