Public Release Type:
Journal
Publication Year: 2013
Authors:
Hoofnagle JH,
Lisker-Melman M,
Khalili M,
Evon DM,
Johnson G,
Wahed AS
Studies:
Hepatitis B Research Network
PURPOSE: Fatigue is the most common symptom of chronic liver disease, including chronic hepatitis B (CHB). Previous studies of fatigue in CHB relied on small sample sizes, single item or nonvalidated measures, and rarely assessed fatigue as a primary endpoint. The HBRN provides a unique opportunity to evaluate fatigue using a brief, standardized tool in a large observational multisite study. AIMS: 1) To assess whether fatigue is more common in patients with CHB compared to the general U.S. population, and 2) To identify sociodemographic and clinical features associated with fatigue. METHODS: Cross-sectional data from the HBRN cohort study involving 21 U.S. and Canadian sites were analyzed. Participants were English-speaking adults not on CHB therapy. Fatigue was measured using a standardized Fatigue 7-item scale developed by the NIH Patient Reported Outcomes Measurement Information System initiative. Higher scores indicate higher fatigue. The fatigue survey was completed by participants at week 48 or 72; clinical data were collected at the same visit. CHB fatigue raw scores were converted to T-scores and compared with U.S. population norms (mean of 50; standard deviation (SD) of 10). Bivariate associations between fatigue and potential sociodemographic and clinical features were explored using simple regression. Multiple linear regression was employed to identify independent correlates of fatigue significant at p<0.05. RESULTS: Data were available for 594 untreated patients: 51% female; mean age of 43; 72% Asian, 15% Caucasian; 12% African-American; 37% inactive carriers; 27% HBeAg negative; 80% with AST-Platelet Ratio Index (APRI) less than 0.5. Fatigue was significantly less in patients with CHB (mean=46.7, SD=7.4) compared to U.S norms (p< .0001). In bivariate analyses, higher fatigue scores were significantly associated with Caucasian race, female sex, higher education, higher BMI, lower albumin, lower HBV DNA, higher APRI, more comorbidities (e.g., HCV and HDV), and taking lipid-lowering or diabetic agents. Fatigue was not associated with CHB phenotype (inactive vs. active), AST or ALT. In the multivariable analysis, lower serum albumin (β (regression coefficient)= -2.00, p=.031), Caucasian race (vs. Asian, β = 3.1, p<.001), more comorbidities (>= 3 vs. 0-2, β = 4.7, p < 0.01), unemployment (β = 2.6, p < 0.01), and post-baccalaureate education (vs. some grade school, β=3.0, p =0.001) were significantly associated with higher fatigue score. CONCLUSIONS: Untreated patients with CHB have less fatigue compared to U.S. general norms. Fatigue in CHB is associated more so with sociodemographic factors than with markers of liver disease.