Fatigue and disease trajectories in chronic liver disease patients: the role of gender and coexistent symptoms.

Abstract

BACKGROUND: Fatigue is a common symptom in chronic liver disease, significantly impacting multiple aspects of quality of life. Although fatigue severity correlates poorly with traditional markers of liver disease activity, greater fatigue has been associated with an increased risk for early death, providing evidence of its prognostic significance (Jones, 2006). Gender differences exist in fatigue reporting yet little is know about gender differences in liver disease. Fatigue in liver disease has been associated with symptoms of sleep disturbance and daytime somnolence yet the relationship of these other symptoms with underlying disease is not well studied. The purpose of this study was to investigate the interrelatedness of fatigue and disease trajectories in patients with chronic liver disease. The intent of this analysis was to explore whether the general level and rate of change over time differs by gender and the presence at baseline of other symptoms. METHOD: A secondary analysis was done of data collected on 150 primary sclerosing cholangitis (PSC) patients who participated in a treatment trial over a 5-year period. Patients completed yearly fatigue questionnaires and quality of life assessments, which included symptom questions, and were assessed on severity of their liver disease by calculation of risk scores. Linear mixed-effect models were used to examine patterns of fatigue and disease, their covariation over time, and the predictive effect of gender and coexistent symptoms. RESULTS: Fatigue increases only slightly over time; yet liver disease severity exhibits an accelerated rate of progression. Female gender, insomnia, concentration difficulty, and itching predict significantly greater fatigue levels. Itching and disease duration were related to disease severity. Although women suffer great fatigue morbidity they do not suffer worse disease. Levels and patterns of fatigue and disease severity do not covary over time, indicating that they are separate processes. CONCLUSIONS: Fatigue levels in liver disease patients remain stable with little increase over time; however disease progresses at an increasing rate of change. Women and those with insomnia, concentration difficulty and itching are more likely to have greater fatigue but not worse disease. No evidence was found of an association between fatigue and disease levels or related patterns of change over time.