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Multicenter Study
. 2016 Apr;61(4):1186-96.
doi: 10.1007/s10620-015-4006-0. Epub 2016 Jan 30.

Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN)

Donna M Evon  1 , Abdus S Wahed  2 , Geoffrey Johnson  2 , Mandana Khalili  3 , Mauricio Lisker-Melman  4 , Robert J Fontana  5 , Souvik Sarkar  6 , Bryce B Reeve  7 , Jay H Hoofnagle  8
Affiliations
Multicenter Study

Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN)

Donna M Evon et al. Dig Dis Sci. 2016 Apr.

Abstract

Background: Fatigue is a common symptom of liver disease but not well characterized in patients with chronic hepatitis B virus (HBV).

Aims: We assessed the rate of fatigue using a validated instrument in patients with HBV and identified demographic, virologic, and clinical features associated with fatigue in a cross-sectional cohort study from the Hepatitis B Research Network.

Methods: Participants were English- and Spanish-speaking adults with chronic HBV who were not pregnant nor on treatment. Fatigue was measured using the PROMIS® Fatigue 7-item Short Form.

Results: The sample included 948 adults: median age 42; 51 % female; 71 % Asian; 74 % college educated; 77 % employed; 41 % inactive HBV carriers; 36 % with active chronic disease; and 2 % with advanced fibrosis, defined as AST-platelet ratio index (APRI) > 1.50. Patients with chronic HBV had a mean fatigue T-score of 46.8 ± SD = 7.9, compared to a mean fatigue T-score of 50.0 ± 10 in the US general population (p < .0001). In univariate analyses, greater fatigue was associated with demographic and clinical features such as female sex, lower income, more comorbidities, higher APRI score, and poorer mental health (p < 0.05). In multivariate analysis, female sex (p < .001), poorer mental health (p < .001), APRI score (p = .005), and history of diabetes (p = .039) were the strongest independent predictors.

Conclusions: The frequency of fatigue in this large cohort of North American chronic HBV patients may be equal to or lower than that reported in the US general population. Patients with advanced fibrosis, more comorbidities, and poorer mental health report worse fatigue.

Keywords: Liver; Mental health; PROMIS; Patient-reported outcomes; Symptoms.

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Figures

Figure 1
Figure 1
Distribution of fatigue T-score in HBV patients in the cohort.
Figure 2
Figure 2. Association between Fatigue T-Score and Mental Health Functioning
Scatter plot of Fatigue T-Score vs SF-36 Mental Health Functioning subscale norm-based score with regression line. Each circle represents a participant or overlapping of participant points.
See this image and copyright information in PMC

Comment in

  • Tired of Hepatitis B?
    Patidar KR, Bajaj JS. Patidar KR, et al. Dig Dis Sci. 2016 Apr;61(4):953-4. doi: 10.1007/s10620-016-4067-8. Dig Dis Sci. 2016. PMID: 26874692 Free PMC article. No abstract available.

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