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)

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

J Hepatol

Keywords

abdominal pain, adult, clinical outcome, comorbidity, conference abstract, controlled study, Cuba, depression, effect size, Egypt, exercise, fatigue, fatty liver, female, Functional Assessment of Chronic Illness Therapy Fatigue Scale, Greece, Hong Kong, human, hypertension, Italy, Japan, liver disease, liver stiffness, major clinical study, Malaysia, male, medical history, metabolic disorder, Mexico, middle aged, non insulin dependent diabetes mellitus, obesity, Pakistan, patient-reported outcome, productivity, Russian Federation, Saudi Arabia, sleep apnea syndromes, Spain, Taiwan, transient elastography

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

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