Prognosis

Longitudinal studies indicate that 17% to 64% of patients improve with treatment; however, less than 10% meet criteria for full recovery, and up to 20% of patients may worsen over time.[278][279][280]​ It is important to review the severity of fatigue and criteria used for ME/CFS diagnoses in these studies. Longitudinal studies also suggest that recovery rates for patients who develop ME/CFS after infectious mononucleosis are better in younger patients than in older patients, with over 50% returning to work after average disease duration of 11.4 years.[281] Findings from one small observational study also suggest that adolescents with ME/CFS after infectious mononucleosis have a higher remission rate than adults and that they also tend to return to full functional capacity.[36] In contrast, less than 10% of patients with ME/CFS without mononucleosis returned to premorbid levels of functioning despite standard therapies.[36] One study carried out in a single tertiary-referral center found improvements within 5 years in a subset of patients with postinfectious ME/CFS who presented with a history of sudden-onset fatigue, fever, tender lymph nodes, and myalgia.[282] Poor prognostic factors include arthralgia, older age, longer illness duration, greater fatigue severity, and presence of comorbid psychiatric illness (self-reported depression).[283]

Evidence regarding excess mortality rates in ME/CFS is limited, and mixed. One small study (n = 56) found that patients with ME/CFS had a younger average age of cardiovascular death (median = 58.8 years) compared with the overall US population (median = 77.7 years).[175] A larger retrospective cohort study (n = 2147) did not note an increased risk of all-cause mortality, but did show a substantially increased risk of death from suicide.[213]

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