Impact of fatigue on patient-reported outcomes and work productivity in chronic hepatitis b and c: insights from a multinational registry study

Abstract

Fatigue in chronic viral hepatitis may be associated with decreased health-related quality of life and other patient-reported outcomes (PROs). We evaluated the relationship between fatigue and PROs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Patients with CHB and CHC enrolled in the Global Liver Registry completed PRO instruments: FACIT-F, CLDQ (for CHB), CLDQ-HCV (for CHC), and WPAI:SHP. Fatigue was defined as FACIT-F Fatigue Scale (FS) score < 30 (scale range: 0–52). Among 2888 patients from 14 countries, 1561 had CHB (mean age 47 ± 13 years; 60% male; 13% advanced fibrosis; 13% depression; 17% fatigue) and 1327 had CHC (50 ± 13 years; 47% male; 21% advanced fibrosis; 18% depression; 28% fatigue). CHB-fatigue was associated with younger age, female, obesity, anxiety, depression (all p < 0.01) and worse PRO scores: CLDQ (scale 1–7): 4.1 ± 0.9 vs. 5.8 ± 0.9; FACIT score (range 0–108): 67.6 ± 14.5 vs. 87.7 ± 13.7; work productivity impairment (range 0–1): 0.33 ± 0.29 vs. 0.11 ± 0.22 (all p < 0.0001). Multivariable analysis confirmed the association of fatigue with lower PRO scores, impairment up to −23% (p < 0.01). CHC-fatigue was associated with female sex, obesity, type 2 diabetes, anxiety, depression (all p < 0.05) and worse PRO scores: CLDQ-HCV: 3.8 ± 1.0 vs. 5.5 ± 1.0; FACIT: 61.8 ± 14.1 vs. 85.6 ± 14.5; work productivity impairment: 0.49 ± 0.32 vs. 0.17 ± 0.25 (all p < 0.0001). In multivariable models, fatigue remained associated with reduced PRO scores, impairment up to −33% (p < 0.01). Almost one in five patients with chronic viral hepatitis report significant fatigue, which is associated with substantial PRO and work productivity impairment. Routine assessment for and management of fatigue in CHC or CHB care is essential.