Chronic Fatigue in Patients with Liver Disease

Introduction:
Chronic fatigue is common in patients with chronic liver disease, particularly cholestatic, sometimes of a severity markedly out of proportion to liver dysfunction. However systematic studies on this debilitated symptom are rare.

Aim:
To study the distribution, severity and possible associations of chronic fatigue in a cohort of patients with chronic liver disease of various aetiologies. Methodology: In 30 patients with liver cirrhosis (19 female, 11 male, age 25-68 yrs, Childs A=4, B=12, C=14) of various aetiologies (PBC= 10, Alcohol= 8, viral= 3, sclerosing cholangitis=3, autoimmune chronic active hepatitis= 2, other= 4) the Bentall mental fatigue score was measured and correlated with clinical and biochemical parameters of liver disease. 30 normal controls of a similar age range had the Bentall score measured.

Results:
Bentall score was 3.5±0.4 (mean±SEM) for controls. 26/30 (86.8%) of patients had a mental fatigue score >mean+2SEM of controls; 11/30 patients scored >15, 5/30 between 10-15 and 10/30 between 5-9. No significant difference in the mean Bentall score was found between males and females, across aetiologies or with the severity of liver disease (Childs score) even after correction for anaemia, age, body mass index (BMI) and renal function. No correlation was found between Bentall score and liver function tests, haemoglobin, prothrombin time or nutritional status (BMI, albumin).

Conclusion:
Chronic fatigue results from an altered (probably centrally mediated) homeostatic mechanism which is deranged independent of the severity and aetiology of liver disease. This mechanism is poorly understood and requires further study.

JN Plevris, JA Cossar"^({*})", MM Dollinger, IAD Bouchier, RE O'Carroll (*), PC Hayes. Liver Research Laboratories University Department of Medicine and Clinical Psychology (*), The Royal Infirmary Edinburgh EH3 9YW

 

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