The Study On Risk And Outcomes Of Fatigue After Ischemic Stroke During Acute Phase

Objectives The purpose of this study was to evaluate the prevalence and its determinants of fatigue after ischemic stroke in acute phase and to explore the effect of acute post-stroke fatigue on the prognosis of ischemic stroke patients.Methods This research was conducted by combining the method of cross-sectional survey and prospective survey and selected objects from ischemic stroke patients. Using cross-sectional survey, We investigated 316 consecutive patients with ischemic stroke during acute phase(the first 2 weeks following after a stroke), who were recruited upon informed consented between July 1, 2013 and December 31, 2013 at the neurology department in two of three grade hospitals in Kaifeng, China, using structured questionnaires including patients’ general demographic characteristics, disease related information and biochemical index, clinical risk factors, family function, depressive symptoms and post-stroke fatigue. Post-stroke fatigue was defined as a score of ≥4 using the Fatigue Severity Scale. After a year, the patients’ survival condition, recurrence status, re-hospitalization and recovery of function were assessed to determine the association between acute post-stroke fatigue and patient’s outcomes by follow-up. Software of Epi Data 3.1 and SPSS 11.5 were applied to establish the datacase and to analyze the data. Univariate analyses, including descriptive analysis, t test, χ2 test, rank test, and multivariate logistic regression were used to analyses.Result1. The average age of 316 acute ischemic stroke patients was 63.11±11.64 years, male 186 cases(58.9%), female 130 cases(41.1%). The majority of participants were married(86.7%), lived in urban area(60.4%), had junior high school and below education(68.7%) and had a family income of more than 2000 RMB/month(73.7%). The proportions of smoking, alcohol drinking and regular physical activity were 32.0%, 30.4% and 71.5% respectively. The majority of patients(83.9%) had no history of stroke, the rates of hypertension, diabetes, coronary heart disease and hyperlipidemia were 60.1%, 25.9%, 18.4% and 39.9%. 2. The average FSS score was 3.48±1.54. During the acute phase after ischemic stroke, 118 patients complained fatigue(FSS≥4). The occurrence of post-stroke fatigue in acute phase was 37.3%. 3. To identify demographic, clinical factors, family function and markers in the blood associated with fatigue after acute ischemic stroke, we first compared patients with versus without post-stroke fatigue in univariate analyses. Acute ischemic stroke patients with post-stroke fatigue were more likely to female gender, live in rural area, have low family income, lack of regular physical activity, family dysfunction, and have coronary heart disease, high NIHSS score, serious MRS, pre-stroke fatigue, sleep disturbances, use of sedative medications and depressive symptoms(P<0.05). 4. A number of independent predictors of fatigue after acute ischemic stroke were revealed in multivariate logistic regression analyses. After the multivariate adjustment, fatigue after acute ischemic stroke was significantly related to lack of regular physical activity(OR 3.722, 95%CI 1.960-7.068), family dysfunction(2.784, 1.435-5.399), having coronary heart disease(3.373, 1.581-7.198), more severe Modified Rankin Scale(4.458, 2.152-9.234), the presence of pre-stroke fatigue(5.377, 2.462-11.743), use of sedative medications(4.069, 1.678-9.868), and depressive symptoms(2.600, 1.306-5.174)(P<0.01).5. After one year follow-up study for the patients, a total of 293 patients were followed up, 23 Results cases were lost, the follow-up rate was 92.7%. The study found that there existed significant difference(P<0.05) in survival condition, re-hospitalization and recovery of function between fatigue group and no fatigue group.Conclusions 1. Lack of regular physical activity, family dysfunction, having coronary heart disease, more severe Modified Rankin Scale, the presence of pre-stroke fatigue, use of sedative medications and depressive symptoms are independent predictors of post-stroke fatigue in acute phase. 2. Post-stroke fatigue in acute phase may increase the risk of death and re-hospitalization in patients with ischemic stroke, also influence the recovery of function.