Prevalence and predictors of fatigue after aneurysmal subarachnoid hemorrhage

Abstract

Background Fatigue is a common and disabling sequel after aneurysmal subarachnoid hemorrhage (aSAH). At present, prevalence estimates of post-aSAH fatigue in the chronic phase are scarce and vary greatly. Factors from the acute phase of aSAH have hitherto barely been associated with post-aSAH fatigue in the chronic phase. Methods Prospective study assessing prevalence of fatigue using the Fatigue Severity Scale (FSS) in patients who were living independently 1 to 7 years after aSAH. We compared demographic, medical, and radiological variables from the acute phase of aSAH between patients with and without fatigue (FSS ≥ 4 versus < 4) and searched for predictors of fatigue among these variables applying univariable and multivariable regression analyses. Results Of 726 patients treated for aSAH in the period between January 2012 and December 2017, 356 patients completed the assessment. The mean FSS score was 4.7 ± 1.7, and fatigue was present in 69.7%. The frequency of patients with fatigue did not decline significantly over time. Univariable analysis identified nicotine use, loss of consciousness at ictus (LOCi), rebleed prior to aneurysm repair, reduced consciousness to Glasgow Coma Scale (GCS) < 14, large amounts of subarachnoid blood, the presence of acute hydrocephalus, and severe vasospasm as factors that were significantly associated with fatigue. In multivariable analysis, nicotine use, reduced GCS, and severe vasospasm were independent predictors that all more than doubled the risk to develop post-aSAH fatigue. Conclusions Fatigue is a frequent sequel persisting several years after aSAH. Nicotine use, reduced consciousness at admission, and severe vasospasm are independent predictors of fatigue from the acute phase of aSAH. We propose inflammatory cytokines causing dopamine imbalance to be a common denominator for post-aSAH fatigue and the presently identified predictors.

Fatigue After Aneurysmal Subarachnoid Hemorrhage: Clinical Characteristics and Associated Factors in Patients With Good Outcome

“…Previous studies have failed to show significant relationships between post-aSAH fatigue and age, gender, education level, aneurysm localization, and treatment modality (Passier et al, 2011a ; Western et al, 2020 ). We presently found higher mean FSS scores but similar MFS sum scores among those with low/intermediate as compared to high education level.…”

“…Remarkably, most aSAH survivors recover without significant neurological deficits, however, even patients with good outcome report substantial problems with fatigue, as well as cognitive and emotional problems (Al-Khindi et al, 2010 ; Nordenmark et al, 2019a ; Nussbaum et al, 2020 ; Tang et al, 2020 ). Fatigue represents the most frequent symptom after aSAH and is found in 50–70% of patients even several years after the hemorrhage (Kutlubaev et al, 2012 ; Western et al, 2020 ).…”

(−)-OSU6162 in the treatment of fatigue and other sequelae after aneurysmal subarachnoid hemorrhage: a double-blind, randomized, placebo-controlled study

“…Notwithstanding, the remarkably stable persistence of post-aSAH fatigue over many years rendered our time frame into a strength. 3,39 Our treatment period of 12 weeks is the longest reported, and reduced efficacy beyond 4 weeks of treatment would not have been detected by the earlier studies administering (−)-OSU6162 for merely 1-4 weeks. [14][15][16]19,31…”

“…1,2 Post-aSAH fatigue is often long-lasting or permanent and has a considerable negative impact on healthrelated quality of life (HRQOL), social functioning, and the ability to return to work (RTW). 1,[3][4][5][6] Fatigue is present in 31%-90% of aSAH survivors and hence poses not only a personal, but also a socioeconomic problem, even in good-outcome aSAH. [1][2][3][5][6][7] Post-aSAH fatigue often occurs together with emotional and cognitive problems, and this cluster of aSAH sequelae has been denoted post-aSAH syndrome.…”

“…1,[3][4][5][6] Fatigue is present in 31%-90% of aSAH survivors and hence poses not only a personal, but also a socioeconomic problem, even in good-outcome aSAH. [1][2][3][5][6][7] Post-aSAH fatigue often occurs together with emotional and cognitive problems, and this cluster of aSAH sequelae has been denoted post-aSAH syndrome. 4 Emotional symptoms like anxiety and depression can be treated medically, but this does not eradicate fatigue.…”