Incidence and related risk factors of post-stroke fatigue in patients with hemorrhagic stroke: a systematic review and meta-analysis

Post-stroke fatigue (PSF) is a long-lasting sequela in patients with hemorrhagic stroke, substantially hindering neurological recovery and social integration. The complex and multifactorial nature of PSF complicates its clinical management, highlighting the need for systematic studies to elucidate its risk factors and facilitate the development of targeted interventions. To evaluate the incidence and developmental trends of PSF and analyze the related risk factors, we conducted a meta-analysis. The databases Web of Science, MEDLINE, PubMed, CINAHL, Embase, Scopus, Cochrane Library, PsycINFO, CNKI, VIP, Wanfang, and SinoMed were systematically searched for publications from inception to February 2025. Two reviewers independently screened the literature, assessed quality, and extracted data. The PSF incidence was performed using Stata 18.0, risk factor analysis was determined using RevMan 5.4. Sixteen studies involving 1,997 patients with hemorrhagic stroke were included ultimately. The incidence of PSF was 51%. Subgroup analyses revealed regional and clinical differences between groups. Marital status(r = 0.24, p < 0.001), sleep disturbance(r = 0.29, p < 0.001), and postoperative complications(r = 0.26, p < 0.001) were weakly correlated with PSF. Moderate correlations were identified for the modified Rankin Scale score(r = 0.37, p < 0.001), Hunt–Hess grade(r = 0.36, p < 0.001), anxiety(r = 0.35, p = 0.001), and social support(r = 0.31, p < 0.001), whereas depression(r = 0.63, p = 0.008) emerged with a strong correlation. Nearly half of patients with hemorrhagic stroke were susceptible to PSF. Variations in the reported PSF incidence across studies may be attributed to the area of onset, study type, disease type, and time of assessment. The early identification of PSF in patients with hemorrhagic stroke is essential for implementing timely and effective interventions.