High prevalence of fatigue in chronic hepatitis and hepatitis C based cirrhosis in contrast to non-viral cirrhosis

Introduction: Chronic fatigue represents a common problem in chronic diseases, particularly chronic liver disease. Therefore we investigated symptoms of fatigue in patients with chronic hepatitis (CH) and liver cirrhosis (LC) of different origin in detail. Methods: 124 patients (81 with CH and 43 with child-A LC but without encephalopathy) were enrolled after informed consent. Patients with inflammatory bowel disease (32) and healthy subjects (38) served as control groups. A Visual Analogue Scale, the Fatigue Severity Scale and the Fatigue Impact Scale were used for grading of fatigue. Further tests and questionnaires were used for the estimation of the influence of fatigue on quality of life, depression, cognition and mental well-being. Results: Overall 50–60% of patients with chronic liver disease (CH and LC) suffered from fatigue (58% of patients with CH, 51% with LC). In the CH group, fatigue was similarly prevalent in all different etiologies (60% in hepatitis C; 61% in hepatitis B; 50% in non viral hepatitis) without statistically significant differences. In contrast, major differences in fatigue were observed in the LC group, where all patients with hepatitis C-based LC (100%) complained about fatigue-related symptoms, but only 25% with alcoholic LC and 40% with other non-viral forms of LC (P<0.05). Fatigue was significantly more frequent in hepatitis C LC compared to non-cirrhotic patients. If present, the severity of fatigue is independent from the underlying disease, but characteristics of the influence on quality of life, cognition and mental health differ between patient groups. Patients with verified fatigue showed mild to moderate depression and significant limitations in quality of life, independently from the etiology of hepatitis or cirrhosis. Fatigue was similarly prevalent in patients with IBD (56%), but showed higher influence on cognition. In contrast to a significant depression in fatigue patients with chronic hepatitis C and IBD, patients with non-viral hepatitis show only a non-significant degree of depression. Conclusions: Fatigue is prevalent in about half of patients with chronic liver or bowel disease and occurs independently of the etiology of CH. However, patients with hepatitis C-associated cirrhosis show the highest prevalence of fatigue compared to alcoholic or other non-viral forms of LC. Our data demonstrate that the coincidence of chronic viral hepatitis C and child-A LC consistently leads to clinically relevant fatigue.

Fatigue - Hepatitis C - Liver cirrhosis