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Digestive Diseases and Sciences

, Volume 61, Issue 4, pp 1186–1196 | Cite as

Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN)

  • Donna M. Evon
  • Abdus S. Wahed
  • Geoffrey Johnson
  • Mandana Khalili
  • Mauricio Lisker-Melman
  • Robert J. Fontana
  • Souvik Sarkar
  • Bryce B. Reeve
  • Jay H. Hoofnagle
Original Article

Abstract

Background

Fatigue is a common symptom of liver disease but not well characterized in patients with chronic hepatitis B virus (HBV).

Aims

We assessed the rate of fatigue using a validated instrument in patients with HBV and identified demographic, virologic, and clinical features associated with fatigue in a cross-sectional cohort study from the Hepatitis B Research Network.

Methods

Participants were English- and Spanish-speaking adults with chronic HBV who were not pregnant nor on treatment. Fatigue was measured using the PROMIS® Fatigue 7-item Short Form.

Results

The sample included 948 adults: median age 42; 51 % female; 71 % Asian; 74 % college educated; 77 % employed; 41 % inactive HBV carriers; 36 % with active chronic disease; and 2 % with advanced fibrosis, defined as AST–platelet ratio index (APRI) > 1.50. Patients with chronic HBV had a mean fatigue T-score of 46.8 ± SD = 7.9, compared to a mean fatigue T-score of 50.0 ± 10 in the US general population (p < .0001). In univariate analyses, greater fatigue was associated with demographic and clinical features such as female sex, lower income, more comorbidities, higher APRI score, and poorer mental health (p < 0.05). In multivariate analysis, female sex (p < .001), poorer mental health (p < .001), APRI score (p = .005), and history of diabetes (p = .039) were the strongest independent predictors.

Conclusions

The frequency of fatigue in this large cohort of North American chronic HBV patients may be equal to or lower than that reported in the US general population. Patients with advanced fibrosis, more comorbidities, and poorer mental health report worse fatigue.

Keywords

Liver Mental health Patient-reported outcomes PROMIS Symptoms 

Abbreviations

HBRN

Hepatitis B Research Network

PROMIS

Patient Reported Outcomes Measurement Information System

APRI

AST–platelet ratio index

HBV

Hepatitis B virus

NIH

National Institutes of Health

SD

Standard deviation

ALT

Alanine aminotransferase test

BMI

Body mass index

MOS SF-36

Medical Outcomes Study 36-item Short Form

HrQOL

Health-related quality of life

Notes

Acknowledgments

The HBRN: Harvard Consortium: Daryl T-Y Lau, MD, MPH (Beth Israel Deaconess Medical Center, Boston, MA), Raymond T. Chung, MD (Massachusetts General Hospital, Boston MA). Minnesota Alliance for Research in Chronic Hepatitis B Consortium Lewis R. Roberts, MB, ChB, PhD (Mayo Clinic Rochester, Rochester, MN), Coleman I. Smith, MD (University of Minnesota, Minneapolis, MN). Midwest Hepatitis B Consortium: Adrian M. Di Bisceglie, MD (Saint Louis University School of Medicine, St Louis, MO). University of Toronto Consortium: Harry L. A. Janssen, MD, PhD (Toronto Western and General Hospitals, Toronto, Ontario), David K. Wong, MD (Toronto Western and General Hospitals, Toronto, Ontario), Joshua Juan, MD (Toronto Western and General Hospitals, Toronto, Ontario), Jordan Feld, MD, MPH (Toronto Western and General Hospitals, Toronto, Ontario), Colina Yim (Toronto Western and General Hospitals, Toronto, Ontario), Jenny Heathcote, MD (Toronto Western and General Hospitals, Toronto, Ontario). HBV CRN North Texas Consortium: William M. Lee, MD (Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas), Robert Perrillo, MD (Baylor University Medical Center, Dallas, TX), Son Do, MD (University of Texas Southwestern, Dallas, TX). Los Angeles Hepatitis B Consortium: Steven-Huy B. Han, MD (David Geffen School of Medicine, UCLA, Los Angeles, CA), Tram T. Tran, MD (Cedars Sinai Medical Center, Los Angeles, CA). San Francisco Hepatitis B Research Group Consortium: Norah A. Terrault, MD, MPH (University of California, San Francisco), Stewart L. Cooper, MD (California Pacific Medical Center, Research Institute and Sutter Pacific Medical Foundation, Division of Hepatology, San Francisco, CA). Michigan Hawaii Consortium: Anna Suk-Fong Lok, MD (University of Michigan, Ann Arbor, MI), Naoky Tsai, MD (The Queen’s Medical Center, University of Hawaii, Honolulu, HI). Chapel Hill, NC Consortium: Michael W. Fried, MD (University of North Carolina at Chapel Hill, Chapel Hill, NC), Keyur Patel, MD (Duke University Medical Center, Durham, NC). PNW/Alaska Clinical Center Consortium: Robert C Carithers, MD (University of Washington Medical Center, Seattle WA), Margaret Shuhart, MD (Harborview Medical Center, Seattle WA), Kris V Kowdley, MD (Virginia Mason Medical Center, Seattle WA), Chia C Wang, MD (Virginia Mason Medical Center, Seattle WA). Virginia Commonwealth University Medical Center: Richard K. Sterling, MD, MSc (Virginia Commonwealth University Health System, Richmond, VA). Liver Diseases Branch, NIDDK: Marc G. Ghany, MD, MHsc (National Institutes of Health, Bethesda, MD), T. Jake Liang, MD (National Institutes of Health, Bethesda, MD). Liver Diseases Research Branch, NIDDK: Edward Doo, MD (National Institutes of Health, Bethesda, MD). Immunology Center: Kyong-Mi Chang, MD (University of Pennsylvania Perelman School of Medicine, Philadelphia, PA), Jang-June Park, PhD (University of Pennsylvania Perelman School of Medicine, Philadelphia, PA). Data Coordinating Center: Steven H. Belle, PhD, MScHyg (Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA), Yona Cloonan, PhD (Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA). Central Pathology: David Kleiner, MD, PhD (Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD). In addition to the authors, the HBRN would like to acknowledge the contributions of the following: Harvard Consortium: Nezam Afdhal, MD, Asad Javaid, MBBS, Jianghe Niu, Johanna Han, Imad Nasser, MD (Beth Israel Deaconess Medical Center, Boston, MA). Minnesota Alliance for Research in Chronic Hepatitis B: Alisha C. Stahler, Linda Stadheim, RN (Mayo Clinic Rochester, Rochester, MN), Mohamed Hassan, MD (University of Minnesota, Minneapolis, MN). Midwest Hepatitis B Consortium: Kathryn Rushing, RN, Rosemary A. Nagy, RDN, LD, MBA, Jacki Cerkoski, RN, MSN (Saint Louis University School of Medicine, St Louis, MO), Debra DeMarco Shaw, RN, BSN, Lisa Kessels, RN, Michael K. Klebert, PhD, RN, ANP-BC (Washington University, St. Louis, MO). University of Toronto Consortium: Seham Noureldin, PhD, Danie La, RN, Lucie Liu, MSc, CCRP, Diana Kaznowski, RN, Jiayun Chen, Doinita Vladutu, Orlando Cerocchi (Toronto Western and General Hospitals, Toronto, Ontario). HBV CRN North Texas Consortium: Stacey Minshall, RN, BSN (Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas), Sheila Bass (University of Texas Southwestern, Dallas, TX), Ethel Sauceda, BS (Baylor University Medical Center, Dallas, TX). Los Angeles Hepatitis B Consortium: Samuel French, MD, Velma Peacock, RN (David Geffen School of Med, UCLA, Los Angeles, CA). San Francisco Hepatitis B Research Group Consortium: Ashley Ungermann, MS, Claudia Ayala, MS, Emma Olson, BS, Ivy Lau, BS (University of California, San Francisco), Veronika Podolskaya, BS, NCPT, Nata DeVole, RN (California Pacific Medical Center, Research Institute). Michigan Hawaii Consortium: Barbara McKenna, MD, Kelly Oberhelman, PAC, Sravanthi Kaza, Bpharm, Cassandra Rodd, BS (University of Michigan, Ann Arbor, MI), Leslie Huddleston, NP, Peter Poerzgen, PhD (The Queen’s Medical Center, University of Hawaii, Honolulu, HI). Chapel Hill, NC Consortium: Jama M. Darling, MD, A. Sidney Barritt, MD, Tiffany Marsh, BA, Vikki Metheny, ANP, Danielle Cardona, PA-C (University of North Carolina at Chapel Hill, Chapel Hill, NC). Virginia Commonwealth University Medical Center: Velimir A. Luketic, MD, Paula G Smith, RN, BSN, Charlotte Hofmann, RN (Virginia Commonwealth University Health System, Richmond, VA). PNW/Alaska Clinical Center Consortium: Alycia Wolfstone, RN, MN (University of Washington Medical Center, Seattle WA), Jody Mooney, Lupita Cardona-Gonzalez (Virginia Mason Medical Center, Seattle WA). Liver Diseases Branch, NIDDK, NIH: Nancy Fryzek, RN, BSN, Elenita Rivera, BSN, Nevitt Morris, Vanessa Haynes-Williams. Liver Disease Research Branch, NIDDK, NIH: Jay H. Hoofnagle, MD, Averell H. Sherker, MD, Edward Doo, MD, Rebecca J. Torrance, RN, MS, Sherry R. Hall, MS. Immunology Center: Mary E. Valiga, RN, Keith Torrey, BS, Danielle Levine, BS, James Keith, BS, Michael Betts, PhD (University of Pennsylvania, Philadelphia, PA), Luis J. Montaner, DVM, DPhil (Wistar Institute, Philadelphia, PA). Data Coordinating Center: Michelle Danielson, PhD, Tamara Haller, Geoffrey Johnson, MS, Stephanie Kelley, MS, Sharon Lawlor, MBA, Joan M. MacGregor, MS, Andrew Pelesko, BS, Donna Stoliker, Ella Zadorozny, MS (Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA).

Declaration of funding interest

The HBRN was funded by a U01 grant from the National Institute of Diabetes and Digestive and Kidney Diseases to the following investigators Lewis R. Roberts, MB, ChB, PhD (DK 082843), Anna Suk-Fong Lok, MD (DK082863), Steven H. Belle, PhD, MScHyg (DK082864), Kyong-Mi Chang, MD (DK082866), Michael W. Fried, MD (DK082867), Adrian M. Di Bisceglie, MD (DK082871), William M. Lee, MD (U01 DK082872), Harry L. A. Janssen, MD, PhD (DK082874), Daryl T-Y Lau, MD, MPH (DK082919), Richard K. Sterling, MD, MSc (DK082923), Steven-Huy B. Han, MD (DK082927), Robert C. Carithers, MD (DK082943), Norah A. Terrault, MD, MPH (U01 DK082944), an interagency agreement with NIDDK: Lilia M. Ganova-Raeva, PhD (A-DK-3002-001), and support from the intramural program, NIDDK, NIH: Marc G. Ghany, MD. Additional funding to support this study was provided to Kyong-Mi Chang, MD, the Immunology Center (NIH/NIDDK Center of Molecular Studies in Digestive and Liver Diseases P30DK50306, NIH Public Health Service Research Grant M01-RR00040), Richard K. Sterling, MD, MSc (UL1TR000058, NCATS (National Center for Advancing Translational Sciences, NIH), Norah A. Terrault, MD, MPH (CTSA Grant Number UL1TR000004), Michael W. Fried, MD (CTSA Grant Number UL1TR001111), and Anna Suk-Fong Lok (CTSA Grant Number UL1RR024986). Additional support was provided by Gilead Sciences, Inc., and Roche Molecular Systems via a CRADA through the NIDDK.

Author contributions

Donna Evon, Souvik Sarkar, and Jay Hoofnagle developed the study concept and design. Geoffrey Johnson and Abdus Wahed conducted the statistical analyses. All authors, including Mandana Khalili, Robert Fontana, and Mauricio Lisker-Melman, were involved in data acquisition and interpretation and drafting and critically revising the manuscript for interpretation and important intellectual content. All authors have made substantial contributions to the research design, data acquisition, analysis and interpretation, and drafting and revising the manuscript and have given approval of the submitted final versions and authorship list.

Compliance with ethical standards

Conflict of interest

Mandana Khalili, Geoffrey Johnson, Wahed Abdus, Souvik Sarkar, and Jay Hoofnagle have no conflict of interests to disclose. Donna Evon has served as a consultant for Gilead. Robert Fontana has received research funding from BMS, Vertex, Gilead and Janssen, and has served as a consultant for GSK and Tibotec. Mauricio Lisker-Melman is on the Speaker’s Bureau for Gilead and Simply Speaking.

References

  1. 1.
    Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50:661–662.CrossRefPubMedGoogle Scholar
  2. 2.
    Bao ZJ, Qiu DK, Ma X, et al. Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy. World J Gastroenterol. 2007;13:3003–3008.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hann HW, Han SH, Block TM, et al. Symptomatology and health attitudes of chronic hepatitis B patients in the USA. J Viral Hepat. 2008;15:42–51.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ozkan M, Corapcioglu A, Balcioglu I, et al. Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. Int J Psychiatry Med. 2006;36:283–297.CrossRefPubMedGoogle Scholar
  5. 5.
    Modabbernia A, Ashrafi M, Malekzadeh R, Poustchi H. A review of psychosocial issues in patients with chronic hepatitis B. Arch Iran Med. 2013;16:114–122.PubMedGoogle Scholar
  6. 6.
    Tillmann HL, Wiese M, Braun Y, et al. Quality of life in patients with various liver diseases: patients with HCV show greater mental impairment, while patients with PBC have greater physical impairment. J Viral Hepat. 2011;18:252–261.CrossRefPubMedGoogle Scholar
  7. 7.
    Lang CA, Conrad S, Garrett L, et al. Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection. J Pain Symptom Manage. 2006;31:335–344.CrossRefPubMedGoogle Scholar
  8. 8.
    Foster GR, Goldin RD, Thomas HC. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology. 1998;27:209–212.CrossRefPubMedGoogle Scholar
  9. 9.
    Kallman J, O’Neil MM, Larive B, Boparai N, Calabrese L, Younossi ZM. Fatigue and health-related quality of life (HRQL) in chronic hepatitis C virus infection. Dig Dis Sci. 2007;52:2531–2539.CrossRefPubMedGoogle Scholar
  10. 10.
    Dwight MM, Kowdley KV, Russo JE, Ciechanowski PS, Larson AM, Katon WJ. Depression, fatigue, and functional disability in patients with chronic hepatitis C. J Psychosom Res. 2000;49:311–317.CrossRefPubMedGoogle Scholar
  11. 11.
    Poynard T, Cacoub P, Ratziu V, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat. 2002;9:295–303.CrossRefPubMedGoogle Scholar
  12. 12.
    Younossi Z, Kallman J, Kincaid J. The effects of HCV infection and management on health-related quality of life. Hepatology. 2007;45:806–816.CrossRefPubMedGoogle Scholar
  13. 13.
    Ashrafi M, Modabbernia A, Dalir M, et al. Predictors of mental and physical health in non-cirrhotic patients with viral hepatitis: a case control study. J Psychosom Res. 2012;73:218–224.CrossRefPubMedGoogle Scholar
  14. 14.
    Poorkaveh A, Modabbernia A, Ashrafi M, et al. Validity, reliability and factor structure of Hepatitis B Quality of Life Questionnaire version 1.0: findings in a large sample of 320 patients. Arch Iran Med. 2012;15:290–297.PubMedGoogle Scholar
  15. 15.
    Pojoga C, Dumitrascu DL, Pascu O, Grigorescu M, Radu C, Damian D. Impaired health-related quality of life in Romanian patients with chronic viral hepatitis before antiviral therapy. Eur J Gastroenterol Hepatol. 2004;16:27–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Bondini S, Kallman J, Dan A, et al. Health-related quality of life in patients with chronic hepatitis B. Liver Int. 2007;27:1119–1125.CrossRefPubMedGoogle Scholar
  17. 17.
    Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59–65.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63:1179–1194.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Reeve BB, Hays RD, Bjorner JB, et al. Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Med Care. 2007;45:S22–S31.CrossRefPubMedGoogle Scholar
  21. 21.
    Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol. 2010;63:1195–1204.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ow YL, Thumboo J, Cella D, Cheung YB, Yong Fong K, Wee HL. Domains of health-related quality of life important and relevant to multiethnic English-speaking Asian systemic lupus erythematosus patients: a focus group study. Arthritis Care Res. 2011;63:899–908.CrossRefGoogle Scholar
  23. 23.
    Koh O, Lee J, Tan ML, et al. Establishing the thematic framework for a diabetes-specific health-related quality of life item bank for use in an english-speaking asian population. PLoS ONE. 2014;9:e115654.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bajaj JS, Thacker LR, Wade JB, et al. PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis. Aliment Pharmacol Ther. 2011;34:1123–1132.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Elliott C, Frith J, Pairman J, Jones DE, Newton JL. Reduction in functional ability is significant postliver transplantation compared with matched liver disease and community dwelling controls. Transpl Int. 2011;24:588–595.CrossRefPubMedGoogle Scholar
  26. 26.
    Newton JL, Elliott C, Frith J, Ghazala C, Pairman J, Jones DE. Functional capacity is significantly impaired in primary biliary cirrhosis and is related to orthostatic symptoms. Eur J Gastroenterol Hepatol. 2011;23:566–572.CrossRefPubMedGoogle Scholar
  27. 27.
    Ghany MG, Perrillo R, Li R, et al. Characteristics of adults in the hepatitis B research network in North America reflect their country of origin and hepatitis B virus genotype. Clin Gastroenterol Hepatol. 2015;13:183–192.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Garcia SF, Cella D, Clauser SB, et al. Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol. 2007;25:5106–5112.CrossRefPubMedGoogle Scholar
  29. 29.
    Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63:1179–1194.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. Boston, MA: New England Medical Center, The Health Institute; 1993.Google Scholar
  31. 31.
    Liu H, Cella D, Gershon R, et al. Representativeness of the Patient-Reported Outcomes Measurement Information System Internet panel. J Clin Epidemiol. 2010;63:1169–1178.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Yost KJ, Eton DT, Garcia SF, Cella D. Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. J Clin Epidemiol. 2011;64:507–516.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Buster EH, Hansen BE, Buti M, et al. Peginterferon alpha-2b is safe and effective in HBeAg-positive chronic hepatitis B patients with advanced fibrosis. Hepatology. 2007;46:388–394.CrossRefPubMedGoogle Scholar
  34. 34.
    Sarkar S, Jiang Z, Evon DM, Wahed AS, Hoofnagle JH. Fatigue before, during and after antiviral therapy of chronic hepatitis C: results from the Virahep-C study. J Hepatol. 2012;57:946–952.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Junghaenel DU, Christodoulou C, Lai JS, Stone AA. Demographic correlates of fatigue in the US general population: results from the patient-reported outcomes measurement information system (PROMIS) initiative. J Psychosom Res. 2011;71:117–123.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ricci JA, Chee E, Lorandeau AL, Berger J. Fatigue in the U.S. workforce: prevalence and implications for lost productive work time. J Occup Environ Med. 2007;49:1–10.CrossRefPubMedGoogle Scholar
  37. 37.
    Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. 1994;308:763–766.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Lam ET, Lam CL, Lai CL, Yuen MF, Fong DY, So TM. Health-related quality of life of Southern Chinese with chronic hepatitis B infection. Health Qual Life Outcomes. 2009;7:52.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Karaivazoglou K, Iconomou G, Triantos C, et al. Fatigue and depressive symptoms associated with chronic viral hepatitis patients. Health-related quality of life (HRQOL). Ann Hepatol. 2010;9:419–427.PubMedGoogle Scholar
  40. 40.
    Levy AR, Kowdley KV, Iloeje U, et al. The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health. 2008;11:527–538.CrossRefPubMedGoogle Scholar
  41. 41.
    Christodoulou C, Junghaenel DU, DeWalt DA, Rothrock N, Stone AA. Cognitive interviewing in the evaluation of fatigue items: results from the patient-reported outcomes measurement information system (PROMIS). Qual Life Res. 2008;17:1239–1246.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Cook KF, Bamer AM, Amtmann D, Molton IR, Jensen MP. Six patient-reported outcome measurement information system short form measures have negligible age- or diagnosis-related differential item functioning in individuals with disabilities. Arch Phys Med Rehabil. 2012;93:1289–1291.CrossRefPubMedGoogle Scholar
  43. 43.
    Junghaenel DU, Schneider S, Stone AA, Christodoulou C, Broderick JE. Ecological validity and clinical utility of Patient-Reported Outcomes Measurement Information System (PROMIS(R)) instruments for detecting premenstrual symptoms of depression, anger, and fatigue. J Psychosom Res. 2014;76:300–306.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kalkanis A, Yucel RM, Judson MA. The internal consistency of PRO fatigue instruments in sarcoidosis: superiority of the PFI over the FAS. Sarcoidosis Vasculitis Diffuse Lung Dis. 2013;30:60–64.Google Scholar
  45. 45.
    DeWalt DA, Rothrock N, Yount S, Stone AA. Evaluation of item candidates: the PROMIS qualitative item review. Med Care. 2007;45:S12–S21.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Donna M. Evon
    • 1
  • Abdus S. Wahed
    • 2
  • Geoffrey Johnson
    • 2
  • Mandana Khalili
    • 3
  • Mauricio Lisker-Melman
    • 4
  • Robert J. Fontana
    • 5
  • Souvik Sarkar
    • 6
  • Bryce B. Reeve
    • 7
  • Jay H. Hoofnagle
    • 8
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Biostatistics, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.Department of MedicineWashington University School of MedicineSt. LouisUSA
  5. 5.Department of MedicineUniversity of MichiganAnn ArborUSA
  6. 6.Department of MedicineUniversity of CaliforniaDavisUSA
  7. 7.Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillUSA
  8. 8.NIDDK Liver Disease Research BranchBethesdaUSA

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