Fatigue is the most common symptom described by patients in populations with the autoimmune liver disease primary biliary cirrhosis.
It appears to be unrelated to liver disease severity.
At present, it is unclear how the fatigue experienced by patients evolves over time.
Dr Jones and colleagues from England assessed how fatigue changes over 4 years of follow up in a geographically defined cohort of primary biliary cirrhosis patients.
The patients had participated in an earlier cross sectional study of fatigue impact.
The patients in the original 2000 study who were still alive in 2004 were asked to complete the same fatigue assessment tool.
In those who had died between 2000 and 2004, medical notes, death certificates, and primary care records were reviewed.
|Fatigued primary biliary cirrhosis patients were more likely to have cardiac death|
The researchers reported that a total of 108 of the original cohort of 136 patients were alive at the time of the follow up study.
Of these, 99 participated in the follow up study to assess fatigue severity.
Fatigue severity was measured by the Fatigue Impact Score.
The team found that all, except 4 patients, showed no change in fatigue severity over 4 years.
The team noted that the remaining 4 patients underwent transplantation between 2000 and 2004, significantly improved in fatigue severity.
Among the 28 patients who died during the follow up period, survival was significantly lower in patients who were fatigued at the 2000 baseline.
The researchers observed that increased fatigue severity was independently associated with decreased survival on multivariate analysis.
Fatigued primary biliary cirrhosis patients were significantly more likely to have suffered a cardiac death than non-fatigued patients.
Dr Jones' team concluded, “The fatigue phenotype appears to be highly stable in primary biliary cirrhosis.”
“The presence of fatigue in primary biliary cirrhosis is independently associated with a significantly increased risk of death in general, and cardiac death in particular.”
“Factors underpinning fatigue in primary biliary cirrhosis, and the mechanisms whereby fatigue is associated with increased mortality, warrant further study.”