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. 2010 Feb;30(2):251-8.
doi: 10.1111/j.1478-3231.2009.02160.x. Epub 2009 Nov 17.

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

Einar Björnsson  1 , Evangelos Kalaitzakis, Matthias Neuhauser, Felicity Enders, Hardy Maetzel, Roger W Chapman, Jayant Talwalkar, Keith Lindor, Roberta Jorgensen
Affiliations

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

Einar Björnsson et al. Liver Int. 2010 Feb.

Abstract

Background: Fatigue was recently suggested to predict an increased risk of mortality in a primary biliary cirrhosis (PBC) cohort during follow-up.

Aims: To analyse the impact of fatigue on prognosis in PBC.

Methods: Patients with PBC who had earlier completed the fatigue impact scale (FIS) were identified. Prognosis in terms of death and liver transplantation (Tx) was determined.

Results: FIS values at baseline were analysed from 208 patients (192 females; median age 59 years (interquartile range 51-67), median follow-up of 5 years. Overall, 181 patients were alive at follow-up, 22 (12%) died and five (2.4%) underwent transplantation. FIS at baseline was 28 (12-47) and FIS at follow-up was 25 (8-64) (P<0.001; r=0.69). Among survivors, FIS at baseline was 27 (12-43), 36 (12-72) in those who died (P=0.059) and 99 (41-102) in those who underwent transplantation (P=0.0008). FIS at baseline was 44 (12-88) in patients with death and/or Tx vs. 27 (12-43) in survivors (P=0.003). Age [hazard ratio (HR) 1.1 (confidence interval (CI) 1.0-1.2)] and aspartate aminotransferase [HR 2.0 (CI 1.3-3.0)] were independently associated with decreased survival on multivariate analysis. FIS scores over 40 [HR 9.6 (CI 2.3-39.7)] and bilirubin [HR 4.8 (CI 2.8-8.2)] were independently associated with a poor outcome in patients who underwent Tx or had a liver-related death.

Conclusions: Fatigue seems to change little over time in PBC. Fatigue levels were higher at baseline in those who died or underwent Tx. High fatigue levels seem to be a predictor of risk of liver-related mortality and need for transplantation over time but not a predictor of non-liver-related mortality.

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