Fatigue is an Important Driver of Work Productivity Loss and Impairment of Patient-Reported Outcomes (PROs) among Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Recommended Citation
Younossi Z, Yilmaz Y, Yu M, Isakov V, Castellanos Fernández MI, Wai-Sun Wong V, Eguchi Y, Romero-Gómez M, Méndez-Sánchez N, Duseja AK, Keklikkiran C, George J, Bugianesi E, Singal AK, Hamid SS, Alswat KA, Chan W, Fan J, Papatheodoridis G, Gordon SC, El-Kassas M, Roberts S, Lam B, Racila A, Henry L, Alqahtani S, Stepanova M. Fatigue is an Important Driver of Work Productivity Loss and Impairment of Patient-Reported Outcomes (PROs) among Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). J Hepatol 2024; 80:S643-S644.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
J Hepatol
Abstract
Background and aims: MASLD is associated with fatigue which can have negative impact on clinical outcomes and PROs. We assessed fatigue among MASLD patients seen in real-world practices. Method:We used data [demographics, medical history, FIB-4 scores, liver stiffness by transient elastography and PRO scores (FACIT-F, CLDQ-NASH, WPAI)] collected by the Global NASH Registry™. Presence of clinically overt fatigue was determined from medical history (MH-based fatigue) or using Fatigue Scale of FACIT-F PRO instrument (FS<30 on a 0–52 scale; PRO-based fatigue). Results: We included 6783 MASLD patients from 18 countries (Australia, China, Cuba, Egypt, Greece, Hong Kong, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Pakistan, Russia, Spain, Taiwan, Turkey, USA): age 51 ± 13 years old, 44% male, 47% employed, 68% obese, 41% type 2 diabetes (T2D), 51% hypertension, 19% with advanced fibrosis (biopsy or transient elastography ≥9.5 kPa or FIB-4 ≥2.67), 24% history of depression, 29% sleep apnea, 20% abdominal pain. Of all patients, 39% had MH-based fatigue and 26% had PRObased fatigue by FACIT-F. Concordance between the two fatigue definitions was 68%, with 44% of those with MH-based fatigue also having PRO-based fatigue (vs. 9% among those without MH-based fatigue). Regardless of the definition, MASLD patients with fatigue were younger (50 vs. 52 years), more commonly female (67% vs. 49%), obese (75% vs. 64%) with T2D (45% vs. 38%), depression (34% vs. 17%) and abdominal pain (33% vs. 10%) (all p < 0.05). Patients with fatigue also reported a substantial impairment in other PRO scores: total CLDQ-NASH score 4.49 (SD 1.08) vs. 5.51 (0.96) in patients with vs. without MH-based fatigue (impairment of −1.02, or −17% of range size), compared to 3.83 (0.91) vs. 5.44 (0.89) in those with vs. without PRO-based fatigue (impairment −1.61, or −27% of range size); similarly total FACIT (4 generic domains of FACIT-F) was −11% by MH-based fatigue and −20% by PRO-based fatigue, and excessive work productivity impairment (WPI) was −13% by the presence of MH-based fatigue and −25% by PRO-based fatigue. After adjustment for clinico-demographic confounders, association of lower PRO scores with fatigue remained significant for all studied PRO scores, with the effect size again being greater for PRO-based fatigue than MH-based fatigue: −20% vs. −10% for total CLDQ-NASH, −16% vs. −6% for FACIT-F, and −21% vs. −7% for WPI (all p < 0.0001). Other predictors of lower PRO scores in MASLD included younger age, female sex, advanced fibrosis, non-hepatic comorbidities, and lack of regular exercise (p < 0.05). Conclusion: MASLD patients experience substantial fatigue burden that is partially captured by medical history and more accurately asserted by a fatigue-specific PRO instrument (FACIT-F). Fatigue is associated with a significant impairment of other PROs and work productivity with its negative economic impact.
Volume
80
First Page
S643
Last Page
S644
