Sarfo Fred S, Berchie Patrick, Singh Arti, Nichols Michelle, Agyei-Frimpong Maria, Jenkins Carolyn, Ovbiagele Bruce
Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Medical University of South Carolina, Charleston, South Carolina.
J Stroke Cerebrovasc Dis. 2019 May;28(5):1353-1361. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.002. Epub 2019 Feb 21.
Poststroke 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.
Study 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.
Sixty-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.
Approximately 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.
中风后疲劳（PSF）在中风幸存者中很常见，对功能缺陷的恢复产生不利影响。在撒哈拉以南非洲地区，PSF的负担尚不清楚。我们评估了60例近期加纳中风患者中PSF的患病率、发展轨迹及预测因素。
本前瞻性队列研究的参与者（于2017年1月至2017年6月招募）为中风幸存者，年龄大于18岁，CT扫描确诊中风发病时间小于1个月。在入组时、第3个月、第6个月和第9个月使用疲劳严重程度量表（FSS）评估PSF。FSS评分大于或等于4分者被归类为“疲劳”。进行多因素逻辑回归分析以确定入组时和第9个月PSF的独立预测因素。
我们样本中的65%为男性，平均年龄55.1±12.7岁。除所有参与者均患有高血压外，85%患有血脂异常，25%患有糖尿病。缺血性中风占研究人群的76.6%。PSF的患病率在基线时为58.9%，在第9个月降至23.6%，P = 0.0002。糖尿病在基线时与PSF显著相关，调整后的优势比为15.12（95%CI：1.70 - 134.30），P = 0.01。然而，在第9个月，年龄大于或等于65岁，调整后的优势比（aOR）为7.02（95%CI：1.16 - 42.52）；女性，aOR为8.52（1.23 - 59.16），以及抑郁，aOR为8.86（1.19 - 65.88）均与PSF独立相关。
约十分之六的加纳中风幸存者在中风发病后的第一个月内经历PSF。在首次中风后10个月，约四分之一的中风幸存者仍存在PSF。需要进一步研究以阐明PSF的潜在机制，迫切期待有足够样本量的多中心干预试验为PSF的临床管理提供坚实的证据基础。
