Association Between Fatigue and Exercise Capacity in Patients With Chronic Liver Disease Awaiting Liver Transplantation

Abstract

BACKGROUND: Fatigue is highly prevalent in end stage liver disease, the studies about its association with exercise capacity in cirrhotic patients before liver are scarse. OBJECTIVE: In this study, we evaluated fatigue in 95 in end stage liver disease patients awaiting transplantation, compared to healthy volunteers, and tested the association between exercise capacity and fatigue. METHODS: Cross-sectional study of patients with chronic liver disease treated at a referral center in Fortaleza, Brazil. Fatigue was quantified with the Fatigue Severity Scale. The patients were submitted to the 6-min walk test, the 6-min step test, the Hospital Anxiety and Depression Scale, C-reative protein measurement and hematocrit count, measurement of dyspnea among other tests. Fatigue data were obtained from healthy individuals for comparison with patients. RESULTS: The mean age of patients was 45.9±12.3 years, and 53.7% were male. Fatigue, anxiety and depression levels were higher among end stage liver disease patients than among controls. A negative correlation was observed between 6 min step test and Fatigue Severity Scale score (r= -0.2; P=0.02) and between hematocrit count and Fatigue Severity Scale score (r= -0.24; P=0.002). Dyspnea on the Borg scale and fatigue were positively correlated (r=31; P=0.002). In the multivariate analysis, low 6-min step test values and high levels of dyspnea were associated with fatigue. CONCLUSION: Fatigue was more prevalent and severe in end stage liver disease patients than in healthy controls. Low 6MST values and high levels of dyspnea were associated with fatigue in this scenario.

Capacity of Exercise and Survival in Patients With Cirrhosis With and Without Hepatopulmonary Syndrome After Liver Transplantation

“…Previous studies have shown that there is a loss in muscle strength and exercise capacity of cirrhotic individuals awaiting liver transplantation, and that this could interfere with the waiting course for this procedure (23,24) . We verified that patients with cirrhosis diagnosed with HPS had a worse survival at two years after the procedure than patients without HPS and that the VO 2 peak, distance walked on the 6MWT and MIP were independent predictors of mortality; this strengthens our idea that HPS can, through changes in oxygenation and gas exchange, affect exercise capacity and functionality and can be a negative aspect in the course of waiting for LT, thus contributing to the lower survival demonstrated by these patients after this procedure.…”

Dilatação vascular intrapulmonar: características clínicas, capacidade funcional e qualidade de vida em indivíduos a espera de transplante de fígado em um hospital universitário

“…Da mesma forma, valores inferiores de P(a-a)O2 foram encontrados no grupo com DVIP, quando comparado aos grupos sem DVIP e com SHP (AGARWAL et al, 2013;DUBROCK et al, 2018;KIM et al, 2004;KÖKSAL et al, 2006;LIMA et al, 2004;MACÊDO et al, 2010;PRZYBYŁOWSKI et al, 2006;YOUNIS et al, 2015). Dois GRILO et al, 2017;MACÊDO et al, 2010;MOCELIN et al, 2019;NACIF et al, 2020;SCHENK et al, 2002;ZHAO et al, 2018) (BEYER et al, 1999;FERNANDES et al, 2019;GALANT et al, 2010GALANT et al, , 2012LEITÃO et al, 2003;LIMA et al, 2019), mas é bem estabelecido que menor distância percorrida é preditor isolado para maior risco de mortalidade nessa população (CAREY et al, 2010;GALANT, 2016)…”