Fatigue and Pruritus in Patients with Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: The Impact on Patient-Reported Outcomes.

Autor: Younossi ZM; Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA USA.; Department of Medicine Center for Liver Diseases Inova Fairfax Hospital Falls Church VA USA., Wong VW; The Chinese University of Hong Kong Hong Kong China., Anstee QM; Clinical & Translational Research Institute Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom.; Newcastle NIHR Biomedical Research Centre Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle-upon-Tyne United Kingdom., Romero-Gomez M; Digestive Diseases UCM Virgen del Rocio University Hospital Institute of Biomedicine of Seville University of Seville Seville Spain., Trauner MH; Division of Gastroenterology and Hepatology Medical University of Vienna Vienna Austria., Harrison SA; Radcliffe Department of Medicine Oxford University Oxford United Kingdom., Lawitz EJ; Texas Liver Institute University of Texas Health San Antonio San Antonio TX USA., Okanoue T; Saiseikai Suita Hospital Suita City, Osaka Japan., Camargo M; Gilead Sciences, Inc. Foster City CA USA., Kersey K; Gilead Sciences, Inc. Foster City CA USA., Myers RP; Gilead Sciences, Inc. Foster City CA USA., Goodman Z; Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA USA.; Department of Medicine Center for Liver Diseases Inova Fairfax Hospital Falls Church VA USA., Stepanova M; Center for Outcomes Research in Liver Disease Washington DC USA.
Jazyk: angličtina
Zdroj: Hepatology communications [Hepatol Commun] 2020 Aug 28; Vol. 4 (11), pp. 1637-1650. Date of Electronic Publication: 2020 Aug 28 (Print Publication: 2020).
DOI: 10.1002/hep4.1581
Abstrakt: Fatigue and pruritus are common in patients with chronic liver diseases of all etiologies, but clinical awareness is mostly restricted to those with cholestatic liver diseases. We assessed the impact of fatigue and pruritus on patient-reported outcomes (PROs) of patients with advanced nonalcoholic steatohepatitis (NASH). Specifically, PROs (Short Form-36, Chronic Liver Disease Questionnaire-NASH, Euro-Qol 5 Dimension, and Work Productivity and Activity Impairment instruments) were assessed at baseline in patients with histologically confirmed bridging fibrosis (F3) or compensated cirrhosis (F4) due to NASH enrolled in STELLAR 3 and 4. Presence of fatigue and pruritus were indicated by a score of 4 or less on the respective items of the Chronic Liver Disease Questionnaire-NASH (scale range, 1-7). Among the included 1,669 patients with advanced NASH (mean age = 58 ± 9 years, 48% F3, 42% with psychiatric comorbidities), 33% and 27% had fatigue and pruritus, respectively. Patients with NASH with fatigue were younger, more likely to be female, cirrhotic, and diabetic, and had higher body mass index and more comorbidities (all P  < 0.05). All PRO scores of patients with fatigue were significantly impaired (mean up to -31% of a PRO range size in comparison to patients without fatigue). In multivariate analysis, predictors of fatigue included diabetes, history of depression or nervous system comorbidities, and lower serum albumin ( P  < 0.05). Patients with pruritus had demographic characteristics similar to those with fatigue, but a higher prevalence of dermatologic comorbidities. All PROs were impaired (by up to -19% of a range size, all P  < 0.01) in patients with NASH with pruritus. Female gender, lower serum albumin, and a history of depression, nervous system, and dermatologic comorbidities were associated with increased risk of pruritus ( P  < 0.05). Conclusion: Clinically significant fatigue and pruritus are common in patients with advanced NASH, and these symptoms negatively affect PROs.
(© 2020 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of the American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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