title: Factors related to fatigue in patients with cirrhosis before and after liver transplantation.
abstract: OBJECTIVE
  We performed a prospective study to evaluate fatigue and identify potential determinants among patients with cirrhosis. We also studied the effects of liver transplantation on fatigue in these patients.
  
  
  METHODS
  A total of 108 patients with cirrhosis being evaluated before liver transplantation completed the fatigue impact scale (FIS), the hospital anxiety and depression (HAD) scale, and the short-form 36 (SF-36). Results were compared with controls from the general population. Fasting serum levels of insulin and glucose were measured in all patients. Levels of serum thyrotropin, free T(3) and T(4), cortisol, free testosterone, dehydroepiandrosterone sulfate, estradiol, interleukin-6, and tumor necrosis factor-α were measured in a subgroup of 80 patients. Transplant recipients were followed for 1 year.
  
  
  RESULTS
  Compared with controls, patients with cirrhosis had more pronounced fatigue, on the basis of higher FIS domain and total scores (P < .05), which were related to all SF-36 domains (r = -0.44 to -0.77, P < .001). All FIS scores improved significantly after liver transplantation, although physical fatigue levels remained higher than in controls (P < .05). In multivariate analysis, pretransplant FIS scores were only related to depression, anxiety, cirrhosis severity, and low serum levels of cortisol (P < .05 for all). Impaired renal function and anemia were independent predictors of physical fatigue (P < .05).
  
  
  CONCLUSIONS
  Fatigue is common among patients with cirrhosis and associated with impaired quality of life. Psychological distress, severity of cirrhosis, and low levels of cortisol determine general fatigue, whereas anemia and impaired renal function also contribute to physical fatigue. Physical fatigue remains of concern for patients who have received liver transplants for cirrhosis.
authors.affiliation: Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. kalvag@hotmail.com
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Axel
authors.initials: A
authors.lastname: Josefsson
authors.forename: Maria
authors.initials: M
authors.lastname: Castedal
authors.forename: Pia
authors.initials: P
authors.lastname: Henfridsson
authors.forename: Maria
authors.initials: M
authors.lastname: Bengtsson
authors.forename: Irene
authors.initials: I
authors.lastname: Hugosson
authors.forename: Bengt
authors.initials: B
authors.lastname: Andersson
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
mesh_terms: D000740:Anemia / Q000150:complications; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D051437:Renal Insufficiency / Q000150:complications; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone