Increased risk of chronic fatigue syndrome following pneumonia: A population-based Cohort study, Hsu et al, 2024

Increased risk of chronic fatigue syndrome following pneumonia: A population-based Cohort study

Abstract
Background
Chronic fatigue syndrome (CFS) has been linked to several conditions, including infections, immune system changes, or emotional stress. Our study aimed to assess the risk of CFS after a pneumonia diagnosis using data from National Health Insurance Research Database of Taiwan.

Methods
In this nested case-control study, we identified 2,000,000 adult patients from a nationwide population-based health insurance claims database spanning from January 1, 2000, to December 31, 2017. Each case diagnosed with a pathogenic infection was matched with a corresponding control using propensity scores. We excluded individuals under 20 years of age, those with a history of pathogenic infections before the index date, or those with more than one potential pathogen. To estimate hazard ratios (HR) and the adjusted hazard ratio (aHR) with their respective 95 % confidence intervals (CI), we applied univariable and multivariable Cox proportional hazard models. The multivariable analysis incorporated adjustments for age, sex, and comorbidity-related confounders.

Results
The relationship between infection and the subsequent risk of CFS was assessed using Cox proportional hazards regression analysis. The incidence density rates were 6.13 and 8.70 per 1000 person‐years among the non‐pulmonary infection and pulmonary infection populations, respectively (adjusted hazard ratio [HR] = 1.4, 95 % confidence interval [CI] 1.32–1.5). Patients infected with Pseudomonas, Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, and influenza virus exhibited a significantly higher risk of CFS than those without these pathogens (p < 0.05). Additionally, patients with pneumonia had a significantly increased risk of thromboembolism compare with control group (p < 0.05).

Journal of Infection and Public Health, Link (open access)

 

ICD-9-CM 780.7 Malaise and fatigue
ICD-10-CM R53.8 Other malaise and fatigue
ICD-10-CM G93.3 Postviral and related fatigue syndromes
ICD-10-CM F48.0 Other nonpsychotic mental disorders

 

I think these authors have published more dan a dozen of these risk factor papers for CFS based on the Taiwanese insurance research database with a separate paper for each risk factor.

I have doubts about the reliability of their database: it is unclear if ME or CFS are recognized diagnoses in Taiwan and if these ICD codes aren't used for other things as well.

 

F48.0 is the old neurasthenia code - I wonder if that's why they included it. See e.g. the 2016 ICD page:

https://icd.who.int/browse10/2016/en#/F40-F48

 

Do they show the hazard ratio just for G 93.3? It’s the only Code that might be relevant

 

From a quick scan, unfortunately not.

 

Thanks for checking.

 

Pneumonia is my most likely cause for this disorder. No surprise at this finding.