Correlation of Fatigue During the Acute Stage of Stroke with Serum Uric Acid and Glucose Levels, Depression, and Disability

Abstract

Background: To clarify the correlation of fatigue during the acute stage of stroke with serum uric acid (UA) and glucose levels, depression, and disability. Design: Cross-sectional descriptive study. Methods: A stroke group of 312 patients and a reference group of 312 healthy controls were recruited during the same period. Fatigue was assessed using the Fatigue Severity Scale (FSS). Patients with an FSS score ≥4 points were defined as having fatigue. Depression was assessed using the Self-rating Depression Scale (SDS). Patients with an SDS score ≥50 points were defined as having depression. Stroke severity and the level of disability were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (MRS). Results: The prevalence of fatigue in the stroke group was higher than that in the reference group (p < 0.001). Within the stroke group, low serum UA level, high MRS score, high serum glucose level, and high SDS score were associated with increased FSS score. The MRS score was associated most consistently with the FSS score (B = 0.411, 95% CI: 0.297, 0.525). Age, gender, chronic disease history, and NIHSS score were not associated with FSS score. Conclusions: Serum UA and glucose levels, depression, and disability are closely related to fatigue during the acute stage of ischaemic stroke.

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…59 Hypersomnia and excessive daytime sleepiness are observed in 27% of patients, 59 whereas insomnia occurs in 57% of patients in the early months after stroke. 60 PSF is associated with sleep disturbances 21,26,31,35,50,[61][62][63] and daytime sleepiness 46,[63][64][65] in many studies, but these associations have not been consistently demonstrated. 20,24,49 The role of sleep disturbances as they pertain to PSF thus remains uncertain.…”

“…14,16,26,27,45,46,48 The presence of heart disease was related to PSF in 2 studies 17,27 but not in 4 others. 14,47,49,50 Generally, cigarette smoking is not considered a risk factor for PSF, as reported in 3 studies. 21,24,27 One study reported that smoking cessation was associated with PSF in patients without depression, 14 suggesting that sudden abstinence of smoking may contribute to PSF.…”

Factors Associated with Poststroke Fatigue: A Systematic Review

“…The great majority of studies (45 out of 48) found a correlation between PSF and poststroke depression [ 13 , 18 , 20 – 22 , 24 – 26 , 29 , 31 , 33 , 35 – 38 , 40 , 41 , 43 , 44 , 46 – 50 , 52 , 53 , 57 – 59 , 61 – 65 , 67 – 69 , 72 , 75 , 77 , 80 – 84 ]. Hence, only three studies failed to observe this type of association [ 23 , 55 , 56 ].…”

“…Six studies found that PSF was associated with stroke severity [ 21 , 22 , 27 , 29 , 33 , 38 , 52 ], although the association was not significant in nondepressed patients [ 33 ]. Sixteen studies did not find this relationship [ 5 , 20 , 31 , 35 , 44 , 46 , 48 – 50 , 53 , 54 , 60 , 63 , 65 , 67 , 68 ]. PSF was linked to long-term mortality rates in three studies [ 20 , 43 , 66 ].…”

“…It has also been postulated that biochemical anomalies (such as vitamin B12 deficiency [ 116 ], low tryptophan levels, and high kynurenine levels [ 117 ]) might be associated with PSF. PSF was also found to be associated with glycemia [ 45 , 53 , 54 ], uric acid levels [ 53 ], and elevated homocysteine levels [ 54 ]. Levels of hemoglobin [ 45 ], total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and fibrinogen were not correlated with PSF [ 54 ].…”