Prevalence and predictors of clinically significant pruritus in patients with non-alcoholic fatty liver disease (NAFLD): data from the global NASH registry™ (GNR™)

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Conference Proceeding

Publication Date


Publication Title

J Hepatol


Background and aims: Pruritus is an important but underappreciated symptom of chronic liver diseases. We assessed factors associated with pruritus among patients with NAFLD. Method: Patients with NAFLD seen in real-world clinical practices were prospectively enrolled in the Global NAFLD/NASH Registry (GNR)™. Clinical parameters and patient reported outcomes (PROs; FACIT-F, CLDQ-NASH, WPAI) were collected. Clinically significant pruritus was defined as score ≤4 in the respective itemof CLDQ-NASH (range 1–7; lower score indicates more severe pruritus). Results:We included 4203 NAFLD subjects from 17 countries: age 52 ± 13 years, 48% male, 48% employed, 23% advanced fibrosis and 14% cirrhosis (by biopsy or non-invasive FIB-4), 44% type 2 diabetes (T2D), 21% history of depression and 45% clinically overt fatigue. Furthermore, 78% of those with a biopsy had NASH. The prevalence of clinically significant pruritus among NAFLD was 28%. The highest prevalence of significant pruritus was in patients enrolled in Middle East/North Africa and Latin America (36–39%), the lowest in South Asia (7%). NAFLD patients with pruritus were less commonly employed (42% vs. 51%), more commonly female (61% vs. 49%) and obese (69% vs 63%). Also, they more commonly had T2D (51% vs 41%), advanced fibrosis (27% vs. 22%), anxiety (47% vs. 31%), depression (30% vs 18%), fatigue (58% vs. 40%), abdominal pain (37% vs. 20%), and sleep apnea (27% vs 21%) (all p < 0.01) than those without pruritus, despite similar age (p > 0.05). NAFLD patients with pruritus experienced significantly lower PRO scores (FACIT-F, CLDQ-NASH, and WPAI) ranging from −4% to −19% of a PRO score range (all p < 0.0001) All CLDQ-NASH domain scores were lower in NAFLD patients with pruritus as compared to those without (Figure). In multivariate analysis adjusted for the regions of enrollment, independent predictors of an increased risk of pruritus included female sex, T2D, depression, clinically overt fatigue, abdominal pain, and the lack of regular (≥3/times week; ≥30 min/time) exercise (odds ratios range 1.30 to 1.96, all p < 0.01). Among patients with 1-year follow-up, lower pruritus scores and higher prevalence of clinically significant pruritus were still observed in patients who had experienced pruritus at baseline: mean pruritus score increased from 3.1 to 4.6 in those with baseline pruritus vs. decreased from 6.4 to 6.0 in those without baseline pruritus while the prevalence of clinically significant pruritus at 1-year follow-up was 52% vs 19%, respectively (all p < 0.0001). [Figure presented] Conclusion: Pruritus is a common and persistent symptom among patients with NAFLD, especially those with T2D and female subjects. Presence of pruritus negatively affects all PRO scores and is impacted by non-hepatic comorbidities.

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Not assigned.



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