title: Fatigue measurements in patients with primary biliary cirrhosis and the risk of mortality during follow-up.
abstract: BACKGROUND
  Fatigue was recently suggested to predict an increased risk of mortality in a primary biliary cirrhosis (PBC) cohort during follow-up.
  
  
  OBJECTIVE
  To analyse the impact of fatigue on prognosis in PBC.
  
  
  METHODS
  Patients with PBC who had earlier completed the fatigue impact scale (FIS) were identified. Prognosis in terms of death and liver transplantation (Tx) was determined.
  
  
  RESULTS
  FIS values at baseline were analysed from 208 patients (192 females; median age 59 years (interquartile range 51-67), median follow-up of 5 years. Overall, 181 patients were alive at follow-up, 22 (12%) died and five (2.4%) underwent transplantation. FIS at baseline was 28 (12-47) and FIS at follow-up was 25 (8-64) (P<0.001; r=0.69). Among survivors, FIS at baseline was 27 (12-43), 36 (12-72) in those who died (P=0.059) and 99 (41-102) in those who underwent transplantation (P=0.0008). FIS at baseline was 44 (12-88) in patients with death and/or Tx vs. 27 (12-43) in survivors (P=0.003). Age [hazard ratio (HR) 1.1 (confidence interval (CI) 1.0-1.2)] and aspartate aminotransferase [HR 2.0 (CI 1.3-3.0)] were independently associated with decreased survival on multivariate analysis. FIS scores over 40 [HR 9.6 (CI 2.3-39.7)] and bilirubin [HR 4.8 (CI 2.8-8.2)] were independently associated with a poor outcome in patients who underwent Tx or had a liver-related death.
  
  
  CONCLUSIONS
  Fatigue seems to change little over time in PBC. Fatigue levels were higher at baseline in those who died or underwent Tx. High fatigue levels seem to be a predictor of risk of liver-related mortality and need for transplantation over time but not a predictor of non-liver-related mortality.
authors.affiliation: Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden. einar.bjornsson@medic.gu.se
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Matthias
authors.initials: M
authors.lastname: Neuhauser
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
authors.forename: Hardy
authors.initials: H
authors.lastname: Maetzel
authors.forename: Roger W
authors.initials: RW
authors.lastname: Chapman
authors.forename: Jayant
authors.initials: J
authors.lastname: Talwalkar
authors.forename: Keith
authors.initials: K
authors.lastname: Lindor
authors.forename: Roberta
authors.initials: R
authors.lastname: Jorgensen
mesh_terms: D000368:Aged; D015897:Comorbidity; D005221:Fatigue / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D018434:Sickness Impact Profile; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology