Review Global prevalence & risk factors of fatigue and post-infectious fatigue among patients with dengue: a systematic review & meta-analysis,2024,Hertanti

https://www.sciencedirect.com/science/article/pii/S2589537024006205

Summary

Background
Fatigue during the acute phase of dengue infection can persist as post-infectious fatigue (PIF), potentially impacting quality of life. We aimed to determine the prevalence and risk factors of fatigue and PIF among dengue patients.

Methods
This systematic review and meta-analysis was registered in the PROSPERO (CRD42024543058). We searched PubMed, Ovid MEDLINE, Web of Science, Embase, and CINAHL from their inception to June 22, 2024. Observational studies reporting the prevalence of fatigue or PIF among dengue patients were included. We excluded case studies, review articles, conference abstracts, protocols, duplicate publications, and studies without full text. Quality assessment was performed using Hoy's risk of bias tool. Data were analyzed using R software version 4.3.3. A random-effects model pooled prevalence with 95% confidence intervals (CIs). Risk factors were identified using odd ratios (ORs) and 95% CIs or p values. Heterogeneity, moderator analysis, sensitivity analysis, and publication bias were also assessed.

Findings
From 715 identified studies, 40 were included for review. Of these, 37 studies were included in the meta-analysis for fatigue prevalence and nine studies for PIF prevalence, respectively involving 37,790 and 5045 dengue patients. The pooled prevalence of fatigue was 59.0% (95% CI 0.47–0.70), and that of PIF was 20.0% (95% CI 0.10–0.36), with significant heterogeneity but no significant moderators. Sensitivity analysis confirmed the robustness of this meta-analysis. Female sex (pooled OR = 1.65, 95% CI 1.27–2.14), dengue hemorrhagic fever (pooled OR = 1.80, 95% CI 1.02–3.16), and preexisting comorbidities (pooled OR = 2.14, 95% CI 1.36–3.38) were significant risk factors for PIF.

Interpretation
This meta-analysis highlights the high prevalence of fatigue and PIF among dengue patients, with several risk factors identified. Although the study has its limitations, these results can inform future studies to more standardized study designs, improved definitions, and systematic assessment methods for fatigue, PIF, and potential moderators. These are essential to better understand the mechanisms of fatigue in dengue patients and explore potential interventions.

Funding
None.

Research in context

Evidence before this study
Fatigue is a subjective feeling of tiredness that can range from mild to severe and impair daily functioning. Post-infectious fatigue (PIF), however, refers to persistent fatigue that lasts for weeks or months after the acute phase of an infection. PIF has been observed in infections such as Q fever, Epstein–Barr virus, Ebolavirus, SARS-CoV-2, and chikungunya, with prevalence ranging from 10% to 50%, depending on the infection. Although fatigue is recognized as a common symptom in dengue, its global prevalence and factors contributing to it in dengue patients have not been systematically studied.

Added value of this study
To the best of our knowledge, this is the first systematic review and meta-analysis to estimate the global prevalence and risk factors of fatigue and PIF following dengue. By including 40 studies across multiple countries, our study provides a comprehensive analysis of these symptoms. The findings emphasize the importance of recognizing fatigue, as almost 60% of dengue patients experience this symptom, and 20% suffer from PIF.

Implications of all the available evidence
The high prevalence of fatigue and PIF among dengue patients emphasizes the need for healthcare professionals to recognize and address fatigue during the acute phase of infection and monitor patients in the convalescent phase. Future research should focus on understanding the mechanisms behind fatigue and PIF in dengue patients and explore potential interventions to prevent the worsening of these conditions and improve patient outcomes.