Fatigue in chronic hepatitis B patients is significant and associates with autonomic dysfunction

Abstract

Background Fatigue is an important clinical finding in patients with chronic hepatitis virus infection. However, studies assessing fatigue in patients with chronic hepatitis B (CHB) are very limited. This study aimed to quantify the severity of fatigue in patients with CHB, to determine whether perceived fatigue reflects impairment of functional ability, and to explore potential causes. Methods A total of 133 patients with histologically proven CHB and 59 community controls were assessed using the fatigue impact scale (FIS). Results The degree of fatigue was significantly higher in patients with CHB than in controls (mean (range) FIS 24.9 (0–91) vs. 15.7 (0–31), p < 0.001). Fatigue experienced by patients with CHB was similar to that in primary biliary cirrhosis (PBC) ( n = 20) (FIS 22.2 vs. 20.9, p = 0.28). No association was found between FIS and biochemistry and histological parameters of liver disease severity. Significant associations were found between fatigue severity and cognitive impairment ( r = 0.39, p < 0.001), daytime somnolence ( r = 0.32, p < 0.001), scores of the Chronic Liver Disease Questionnaire ( r = − 0.31, p < 0.001), and autonomic symptoms ( r = 0.43, p < 0.001). The level of autonomic symptom was the only factor independently associated with the degree of fatigue. Conclusion Fatigue is a significant problem of functional ability impairment in CHB and similar in degree to that in PBC patients. Fatigue in patients with CHB appears to be unrelated to the severity of liver disease but is associated with significant autonomic symptoms.

Autonomic dysfunction in patients with COVID‑19

“…Fatigue appears to be a very common presentation of the disease both at the acute and post infectious stages of COVID-19 [25]. It was reported to be directly related to autonomic dysfunction in some of the reported studies [26] and the relationship of fatigue with autonomic dysfunction in some other neurological diseases such as multiple sclerosis [27], Parkinson's disease [28], sleep disorders [29] and chronic hepatitis [30] is also well known. Although Towsend et al reported that there was no difference in terms of autonomic dysfunction symptoms between patients with fatigue and non-fatigue [31], our results show that the presence of fatigue at the acute stage of SARS-CoV-2 infection increases the risk of autonomic dysfunction by 2.2 folds at the post COVID phase.…”

Liver Transaminases in Pediatric Adenovirus Infection—A Five-Year Study in Two Major Reference Centers from Romania

“…Lethargy was a clinical indicator of the presence of hepatic cytolysis in our study. Patients with acute viral hepatitis may show a high degree of fatigue and lethargy, which may be related to the severity of liver disease [ 39 , 40 ]. The direct association of cytolysis with vomiting and dehydration identified by us has not been clearly described to date, especially for cases of HAdV infection.…”

The Neuropsychiatric Aspect of the Chronic Viral Hepatitis

“…Chronic viral hepatitis can also cause long-term brain dysfunction, which significantly worsens the quality of life and may even persist after the elimination of the virus (Dirks et al, 2017). With chronic HBV-infection, the quality of life may also be worsened due to the appearance of fatigue, cognitive impairment and sleep disorders (Wang et al, 2019).…”

“…Cortisol, IL-6, and TNF-α were associated with levels of perceived fatigue, especially cognitive impairment in patients with HBV infection. The characteristic of fatigue in patients with chronic liver disease was noted as central fatigue (Wang et al, 2019). Some studies have shown that fatigue is a true and specific sign of HDV-infection that negatively affects the quality of life, while a significant proportion of fatigue in HBV is associated with the presence of autonomic dysfunction (Ekerfors et al, 2019).…”