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


Einar Björnsson, Sahlgrenska University Hospital, Med pol II, 413 45, Gothenburg, Sweden Tel: +46 31 342 10 00
Fax: +46 31 82 21 52
e-mail: einar.bjornsson@medic.gu.se


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.