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.
Article PDF
Similar content being viewed by others
References
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.
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.
Björnsson E, Simren M, Olsson R, Chapman RW. Fatigue in patients with primary sclerosing cholangitis. Scand J Gastroenterol 2004; 39: 961–968.
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.
Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet 2004; 363: 978–988.
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.
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.
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.
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995; 273: 59–65.
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.
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.
Taylor RR, Jason LA, Torres A. Fatigue rating scales: an empirical comparison. Psychol Med 2000; 30: 849–856.
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.
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.
Cauch-Dudek K, Abbey S, Stewart DE, Heathcote EJ. Fatigue in primary biliary cirrhosis. Gut 1998; 43: 705–710.
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.
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.
Miaskowski C. Gender differences in pain, fatigue, and depression in patients with cancer. J Natl Cancer Inst Monogr 2004; 139–143.
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.
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.
Verbrugge LM. Gender and health: an update on hypotheses and evidence. J Health Soc Behav 1985; 26: 156–182.
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.
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.
Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000; 118: 372–379.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1110-7782.193892