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The Egyptian Journal of Internal Medicine
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Etiology and prevalence of fatigue in chronic liver disease: clinical view

The Egyptian Journal of Internal Medicine volume 28, pages 78–85 (2016)Cite this article

Abstract

Introduction and aim

Fatigue is one of the most common and prominent symptoms in liver cirrhosis and was reported in 60–80% of these patients. The study outcome was to prospectively evaluate the etiology and the degree of fatigue and how to improve it in chronic liver disease patients.

Patients and methods

A prospective cross-sectional study on fatigue in chronic liver diseases was conducted on 500 patients: 475 patients had hepatitis C virus (HCV) and 25 had combined HCV and hepatitis B virus. They were divided into five groups: group 1 included 100 patients with chronic hepatitis, group 2 included 100 patients with Child class A cirrhosis, group 3 included 100 patients with Child class B cirrhosis, group 4 included 100 patients with Child class C cirrhosis, and group 5 included 100 patients with hepatocellular carcinoma (HCC). They were administered the Fatigue Impact Scale and the Fatigue Severity Scale questionnaires (translated into Arabic) as well as subjected to laboratory investigations, abdominal ultrasonography, and upper endoscopy.

Results

All (100%) patients complained of longstanding fatigue. HCC had the highest prevalence of high fatigue (65%) and Child class C cirrhosis had the longest fatigue duration. Female sex and anemia were significantly related to both the Fatigue Impact Scale and the Fatigue Severity Scale in each group separately and all patients collectively. Age had a significant relation with all patients collectively but not separately. Fatigue scores were related to Child score but not related to liver profile, α-fetoprotein, varices, ascites, and HCV load.

Conclusion

Correction of anemia, not liver profile, helps in alleviating fatigue in cirrhotic patients. Female patients suffered from fatigue more frequently compared with male patients. HCC patients had highest fatigue and patients with Child class C cirrhosis had longest fatigue indices.

References

  1. Huet PM, Deslauriers J, Tran A, Faucher C, Charbonneau J. Impact of fatigue on the quality of life of patients with primary biliary cirrhosis. Am J Gastroenterol 2000; 95: 760–767.

    Article  CAS  Google Scholar 

  2. Stanca CM, Bach N, Krause C, Tandon N, Freni MA, Gutierrez JA, et al. Evaluation of fatigue in U.S. patients with primary biliary cirrhosis. Am J Gastroenterol 2005; 100: 1104–1109.

    PubMed  Google Scholar 

  3. Björnsson E, Simren M, Olsson R, Chapman RW. Fatigue in patients with primary sclerosing cholangitis. Scand J Gastroenterol 2004; 39: 961–968.

    Article  Google Scholar 

  4. Björnsson E, Simren M, Olsson R, Chapman RW, Björnsson E, Simren M, et al. Fatigue is not a specific symptom in patients with primary biliary cirrhosis. Eur J Gastroenterol Hepatol 2005; 17: 351–357.

    Article  Google Scholar 

  5. Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet 2004; 363: 978–988.

    Article  Google Scholar 

  6. Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF. Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 1994; 18 (Suppl 1): S79–S83.

    Article  Google Scholar 

  7. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121–1123.

    CAS  PubMed  Google Scholar 

  8. Sogolow ED, Lasker JN, Short LM. Fatigue as a major predictor of quality of life in women with autoimmune liver disease: the case of primary biliary cirrhosis. Womens Health Issues 2008; 18: 336–342.

    Article  Google Scholar 

  9. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995; 273: 59–65.

    CAS  Google Scholar 

  10. Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G. Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol 2001; 96: 2199–2205.

    Article  CAS  Google Scholar 

  11. Prince MI, James OF, Holland NP, Jones DE. Validation of a fatigue impact score in primary biliary cirrhosis: towards a standard for clinical and trial use. J Hepatol 2000; 32: 368–373.

    Article  CAS  Google Scholar 

  12. Taylor RR, Jason LA, Torres A. Fatigue rating scales: an empirical comparison. Psychol Med 2000; 30: 849–856.

    Article  CAS  Google Scholar 

  13. Sumskiene J, Sumskas L, Petrauskas D, Kupcinskas L. Disease-specific health-related quality of life and its determinants in liver cirrhosis patients in Lithuania. World J Gastroenterol 2006; 12: 7792–7797.

    Article  Google Scholar 

  14. Mahmood S, Kida1 T, Izumi1 A, Sasaki C, Okamoto H, Kobayashi H, et al. Assessment of health related quality of life in chronic liver disease patients using the Japanese versions of CLDQ and SF-36. Gastroenterol J 2008; 2: 57–63.

    Google Scholar 

  15. Cauch-Dudek K, Abbey S, Stewart DE, Heathcote EJ. Fatigue in primary biliary cirrhosis. Gut 1998; 43: 705–710.

    Article  CAS  Google Scholar 

  16. Gao R, Gao F, Li G, Shang ZM, Hao JY. Health-related quality of life in Chinese patients with chronic liver disease. Gastroenterol Res Pract 2012; 2012: 516140.

    Article  Google Scholar 

  17. Afendy A, Kallman JB, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, et al. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther 2009; 30: 469–476.

    Article  CAS  Google Scholar 

  18. Miaskowski C. Gender differences in pain, fatigue, and depression in patients with cancer. J Natl Cancer Inst Monogr 2004; 139–143.

  19. Baldwin CM, Grant M, Wendel C, Hornbrook MC, Herrinton LJ, McMullen C, et al. Gender differences in sleep disruption and fatigue on quality of life among persons with disabilities. J Clin Sleep Med 2009; 5: 335–343.

    Article  Google Scholar 

  20. Macintyre S, Ford G, Hunt K. Do women ‘over-report’ morbidity? Men’s and women’s responses to structured prompting on a standard question on longstanding illness. Soc Sci Med 1999; 48: 89–98.

    Article  CAS  Google Scholar 

  21. Verbrugge LM. Gender and health: an update on hypotheses and evidence. J Health Soc Behav 1985; 26: 156–182.

    Article  CAS  Google Scholar 

  22. Gijsbers van Wijk CM, van Vliet KP, Kolk AM, Everaerd WT. Symptom sensitivity and sex differences in physical morbidity: a review of health surveys in the United States and the Netherlands. Women Health 1991; 17: 91–124.

    Article  CAS  Google Scholar 

  23. Stommel M, Given BA, Given CW, Kalaian HA, Schulz R, McCorkle R. Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D). Psychiatry Res 1993; 49: 239–250.

    Article  CAS  Google Scholar 

  24. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000; 118: 372–379.

    Article  CAS  Google Scholar 

  25. Atiq M, Gill ML, Khokhar N. Quality of life assessment in Pakistani patients with chronic liver disease. J Pak Med Assoc 2004; 54: 113–115.

    CAS  PubMed  Google Scholar 

  26. Rosa K, Fu M, Gilles L, Cerri K, Peeters M, Bubb J, Scott J Validation of the Fatigue Severity Scale in chronic hepatitis C. Health Qual Life Outcomes 2014; 12: 90.

    Article  Google Scholar 

  27. Sinakos E, Gigi E, Lalla T, Bellou AL, Sykja A, Orphanou E, et al. Healthrelated quality of life in Greek chronic hepatitis C patients during pegylated interferon and ribavirin treatment. Hippokratia 2010; 14: 122–125.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Dan AA, Martin LM, Crone C, Ong JP, Farmer DW, Wise T, et al. Depression, anemia and health-related quality of life in chronic hepatitis C. J Hepatol 2006; 44: 491–498.

    Article  Google Scholar 

  29. Gergely AE, Lafarge P, Fouchard-Hubert I, Lunel-Fabiani F. Treatment of ribavirin/interferon-induced anemia with erythropoietin in patients with hepatitis C. Hepatology 2002; 35: 1281–1282.

    Article  Google Scholar 

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Authors and Affiliations

  1. Hepatogastroenterology and Endemic Medicine Department, Faculty of Medicine, Cairo University, 63, Abo Dawood El-Thahery St, Cairo, 11765, Cairo, Egypt

    Zakaria A. Salama, Samar K. Darweesh MD & Hany M. Shehab

  2. Hepatogastroenterology Department, Police Hospital, Cairo, Egypt

    Manal A. Abd-Elhameed

Authors
  1. Zakaria A. Salama
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  2. Samar K. Darweesh MD
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  3. Hany M. Shehab
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  4. Manal A. Abd-Elhameed
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Corresponding author

Correspondence to Samar K. Darweesh MD.

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Salama, Z.A., Darweesh, S.K., Shehab, H.M. et al. Etiology and prevalence of fatigue in chronic liver disease: clinical view. Egypt J Intern Med 28, 78–85 (2016). https://doi.org/10.4103/1110-7782.193892

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  • DOI: https://doi.org/10.4103/1110-7782.193892

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