Fatigue measurements in patients with primary biliary cirrhosis and the risk of mortality during follow-up

Bjõrnsson, Einar; Kalaitzakis, Evangelos; Neuhauser, Matthias; Enders, Felicity; Maetzel, Hardy; Chapman, Roger W.; Talwalkar, Jayant A.; Lindor, Keith D.; Jorgensen, Roberta A.

doi:10.1111/j.1478-3231.2009.02160.x

Cited by 25 publications

(14 citation statements)

References 22 publications

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“…Future studies will also need to be particular in having uniform criteria in the definition and assessment of comorbidities and assessing for other causes of fatigue, The presence of fatigue in other liver disease supports our overarching findings. Future studies are required to validate and refine our findings, particularly in clinic populations from different parts of the world, and where possible with longitudinal evaluation of the significance of any observations to outcomes, because this remains a point of concern 8. Additionally the methods we applied to define comorbidities likely underreport such associations, because more formal involved evaluations of patients would be helpful.…”

Section: Discussionmentioning

confidence: 96%

“…In addition to the potential for liver‐related morbidity and mortality, it is recognized that patients with PBC frequently suffer from a marked impairment in their quality of life (QOL) 2. Fatigue has been identified as one of the principal factors contributing to this functional impairment across most studies of patients with PBC, and this potentially disabling symptom is reported to significantly affect a variable minority of patients 3‐8…”

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confidence: 99%

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The specificity of fatigue in primary biliary cirrhosis: Evaluation of a large clinic practice

et al. 2010

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Quality of life is an important concern for patients with chronic liver disease. We sought to describe the frequency, severity, and associations of fatigue, in patients with primary biliary cirrhosis (PBC). We performed association testing between PBC-40 multidomain disease-specific quality of life responses and clinical findings. Three hundred twenty-seven patients from a single clinic with PBC (94% female, 92% AMA-positive) were evaluated. The average age was 57 years and average disease duration 7.2 years. Verbally reported fatigue was noted in 48% but present in the overwhelming majority on PBC-40 completion, with 44% having moderate or severe symptoms. Of those not complaining of fatigue clinically, 25% documented moderate or severe fatigue by questionnaire. Age had an inverse relationship with fatigue (P < 0.01), whereas body mass index (BMI) was positively associated (P < 0.01), as was the presence of pruritus (P < 0.001), sicca symptoms (P < 0.001), depression (P < 0.001), fibromyalgia (P < 0.004), and scleroderma (P < 0.05). For those with varices (P < 0.05) or cirrhosis clinically (P < 0.05), higher fatigue scores were noted, although those who initially presented with noncirrhotic disease had higher scores at the time of testing (P < 0.005). Fatigue was associated with greater use of prescription medication (P < 0.01), in particular for antipruritics (cholestyramine: P < 0.001; rifampin: P < 0.001), proton pump inhibitors (P < 0.002), beta-blockers (P < 0.02), and antidepressants (P < 0.001), whereas those taking calcium and vitamin D appeared less fatigued (P < 0.05). In a multivariate model, calcium and vitamin D use, BMI, stage of disease at diagnosis, as well as symptomatic fatigue or pruritus, were significant. Biochemical response to UDCA was not associated with lower fatigue scores. Conclusion: Attempts at defining the biological basis of fatigue in patients with PBC, and improving its treatment, must account for its multifactoral causes. (HEPATOLOGY 2010;52:562-570)

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

The specificity of fatigue in primary biliary cirrhosis: Evaluation of a large clinic practice

et al. 2010

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“…In particular, major negative associations between fatigue and pruritus and HRQoL have been reported . In addition, some authors have proposed that fatigue might be a predictor of increased mortality in patients with PBC . Due to the subjective nature of extrahepatic symptoms in patients with PBC, a number of disease‐specific tools assessing the quality of life in the context of PBC have been developed.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 In addition, some authors have proposed that fatigue might be a predictor of increased mortality in patients with PBC. 6,7 Due to the subjective nature of extrahepatic symptoms in patients with PBC, a number of disease-specific tools assessing the quality of life in the context of PBC have been developed. The most commonly used questionnaire, namely the PBC-40, has been validated as a PBC-specific tool assessing the impairment of HRQoL.…”

Section: Introductionmentioning

confidence: 99%

Effects of liver transplantation on health‐related quality of life in patients with primary biliary cholangitis

Krawczyk

Koźma

Szymańska

et al. 2018

Clinical Transplantation

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Background Patients with primary biliary cholangitis (PBC) have decreased health‐related quality of life (HRQoL). Here, we investigate HRQoL in two cohorts of transplanted patients with PBC and compare their results to healthy subjects. Patients and Methods We used generic SF‐36 and disease‐specific PBC‐40 questionnaires to evaluate HRQoL in 26 patients with PBC (23 females, age 59.4 ± 5.7 years) before and after liver transplantation (LT), and in 107 patients with PBC (99 females, age 62.8 ± 6.7 years) who were previously transplanted. The control group was comprised of 60 healthy controls (55 females, age 54.6 ± 8.8 years). Results Health‐related quality of life improved after LT in 85% of PBC patients. The SF‐36 measure showed significant (all P < 0.05) improvements in the majority of domains after LT, and in the summary scores both physical and mental. We also documented significant improvements in pruritus and fatigue after LT (all P < 0.01). However, liver graft recipients had significantly worse physical functioning, physical role, and emotional role domains, and physical component score (all P < 0.001), as compared to healthy subjects. No differences in HRQoL were detected between patients evaluated after short and prolonged post‐LT periods (P > 0.05). Conclusion Liver transplantation substantially improves most aspects of life quality in PBC patients. Nevertheless, their HRQoL remains worse in comparison to healthy individuals, mainly in physical aspects.

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“…23 a 2009 study reports that fatigue seems to change little over time (median followup period 5 years) in patients with PBC. 80 Fatigue levels were higher (a median Fis >28) at baseline in patients with PBC who subsequently died or underwent treatment. High levels of fatigue at baseline seem to be a predictor of risk of liverrelated mortality and need for transplantation over time but not a predic tor of nonliverrelated mortality.…”

Section: Differential Diagnosismentioning

confidence: 95%

Fatigue in primary biliary cirrhosis

Abbas

Jorgensen

Lindor

2010

Nat Rev Gastroenterol Hepatol

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Primary biliary cirrhosis (PBC) is a chronic, autoimmune, cholestatic liver disease with a slowly progressive course. Without treatment, most patients eventually develop fibrosis of the liver and may need liver transplantation in the late stage of disease. Fatigue and pruritus are the most common symptoms of PBC, but the majority of patients are asymptomatic at first presentation. There is no specific treatment for fatigue in PBC, but modafinil has shown some potential beneficial effects, such as increased energy levels and decreased total sleep time. This Review article discusses the natural history and the measurement of fatigue in patients with PBC. The central and the peripheral mechanisms that have been suggested for the pathogenesis of fatigue in PBC are also discussed and treatment options are reviewed.

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Fatigue measurements in patients with primary biliary cirrhosis and the risk of mortality during follow-up

Cited by 25 publications

References 22 publications

The specificity of fatigue in primary biliary cirrhosis: Evaluation of a large clinic practice

The specificity of fatigue in primary biliary cirrhosis: Evaluation of a large clinic practice

Effects of liver transplantation on health‐related quality of life in patients with primary biliary cholangitis

Fatigue in primary biliary cirrhosis

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