title: Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN).
abstract: BACKGROUND
  Fatigue is a common symptom of liver disease but not well characterized in patients with chronic hepatitis B virus (HBV).
  
  
  OBJECTIVE
  We assessed the rate of fatigue using a validated instrument in patients with HBV and identified demographic, virologic, and clinical features associated with fatigue in a cross-sectional cohort study from the Hepatitis B Research Network.
  
  
  METHODS
  Participants were English- and Spanish-speaking adults with chronic HBV who were not pregnant nor on treatment. Fatigue was measured using the PROMIS® Fatigue 7-item Short Form.
  
  
  RESULTS
  The sample included 948 adults: median age 42; 51 % female; 71 % Asian; 74 % college educated; 77 % employed; 41 % inactive HBV carriers; 36 % with active chronic disease; and 2 % with advanced fibrosis, defined as AST-platelet ratio index (APRI) > 1.50. Patients with chronic HBV had a mean fatigue T-score of 46.8 ± SD = 7.9, compared to a mean fatigue T-score of 50.0 ± 10 in the US general population (p < .0001). In univariate analyses, greater fatigue was associated with demographic and clinical features such as female sex, lower income, more comorbidities, higher APRI score, and poorer mental health (p < 0.05). In multivariate analysis, female sex (p < .001), poorer mental health (p < .001), APRI score (p = .005), and history of diabetes (p = .039) were the strongest independent predictors.
  
  
  CONCLUSIONS
  The frequency of fatigue in this large cohort of North American chronic HBV patients may be equal to or lower than that reported in the US general population. Patients with advanced fibrosis, more comorbidities, and poorer mental health report worse fatigue.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA. donna_evon@med.unc.edu.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Evon
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Abdus S
authors.initials: AS
authors.lastname: Wahed
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Johnson
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Mandana
authors.initials: M
authors.lastname: Khalili
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Lisker-Melman
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.affiliation: Department of Medicine, University of California, Davis, CA, USA.
authors.forename: Souvik
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.affiliation: NIDDK Liver Disease Research Branch, Bethesda, MD, USA.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Hoofnagle
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000453:epidemiology / Q000821:virology*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: Liver; Mental health; PROMIS; Patient-reported outcomes; Symptoms
references.citation: J Psychosom Res. 2000 Nov;49(5):311-7
references.pmid: 11164055
references.citation: Am J Gastroenterol. 2001 Jul;96(7):2199-205
references.pmid: 11467653
references.citation: J Viral Hepat. 2002 Jul;9(4):295-303
references.pmid: 12081607
references.citation: Eur J Gastroenterol Hepatol. 2004 Jan;16(1):27-31
references.pmid: 15095849
references.citation: BMJ. 1994 Mar 19;308(6931):763-6
references.pmid: 7908238
references.citation: JAMA. 1995 Jan 4;273(1):59-65
references.pmid: 7996652
references.citation: Hepatology. 1998 Jan;27(1):209-12
references.pmid: 9425939
references.citation: J Pain Symptom Manage. 2006 Apr;31(4):335-44
references.pmid: 16632081
references.citation: J Occup Environ Med. 2007 Jan;49(1):1-10
references.pmid: 17215708
references.citation: Int J Psychiatry Med. 2006;36(3):283-97
references.pmid: 17236696
references.citation: Hepatology. 2007 Mar;45(3):806-16
references.pmid: 17326207
references.citation: Med Care. 2007 May;45(5 Suppl 1):S12-21
references.pmid: 17443114
references.citation: Med Care. 2007 May;45(5 Suppl 1):S22-31
references.pmid: 17443115
references.citation: World J Gastroenterol. 2007 Jun 7;13(21):3003-8
references.pmid: 17589955
references.citation: Hepatology. 2007 Aug;46(2):388-94
references.pmid: 17604363
references.citation: Dig Dis Sci. 2007 Oct;52(10):2531-9
references.pmid: 17406828
references.citation: Liver Int. 2007 Oct;27(8):1119-25
references.pmid: 17845541
references.citation: J Clin Oncol. 2007 Nov 10;25(32):5106-12
references.pmid: 17991929
references.citation: J Viral Hepat. 2008 Jan;15(1):42-51
references.pmid: 18088244
references.citation: Value Health. 2008 May-Jun;11(3):527-38
references.pmid: 18179664
references.citation: Qual Life Res. 2008 Dec;17(10):1239-46
references.pmid: 18850327
references.citation: Health Qual Life Outcomes. 2009;7:52
references.pmid: 19500349
references.citation: Hepatology. 2009 Sep;50(3):661-2
references.pmid: 19714720
references.citation: J Clin Epidemiol. 2010 Nov;63(11):1179-94
references.pmid: 20685078
references.citation: J Clin Epidemiol. 2010 Nov;63(11):1195-204
references.pmid: 20688471
references.citation: J Clin Epidemiol. 2010 Nov;63(11):1169-78
references.pmid: 20688473
references.citation: Ann Hepatol. 2010 Oct-Dec;9(4):419-27
references.pmid: 21057161
references.citation: J Viral Hepat. 2011 Apr;18(4):252-61
references.pmid: 20337922
references.citation: J Clin Epidemiol. 2011 May;64(5):507-16
references.pmid: 21447427
references.citation: Transpl Int. 2011 Jun;24(6):588-95
references.pmid: 21382100
references.citation: Arthritis Care Res (Hoboken). 2011 Jun;63(6):899-908
references.pmid: 21425244
references.citation: Eur J Gastroenterol Hepatol. 2011 Jul;23(7):566-72
references.pmid: 21593676
references.citation: J Psychosom Res. 2011 Sep;71(3):117-23
references.pmid: 21843744
references.citation: Aliment Pharmacol Ther. 2011 Nov;34(9):1123-32
references.pmid: 21929591
references.citation: Arch Iran Med. 2012 May;15(5):290-7
references.pmid: 22519378
references.citation: Arch Phys Med Rehabil. 2012 Jul;93(7):1289-91
references.pmid: 22386213
references.citation: J Psychosom Res. 2012 Sep;73(3):218-24
references.pmid: 22850263
references.citation: J Hepatol. 2012 Nov;57(5):946-52
references.pmid: 22760009
references.citation: Arch Iran Med. 2013 Feb;16(2):114-22
references.pmid: 23360635
references.citation: Sarcoidosis Vasc Diffuse Lung Dis. 2013 Mar;30(1):60-4
references.pmid: 24003536
references.citation: J Psychosom Res. 2014 Apr;76(4):300-6
references.pmid: 24630180
references.citation: Clin Gastroenterol Hepatol. 2015 Jan;13(1):183-92
references.pmid: 25010003
references.citation: PLoS One. 2014;9(12):e115654
references.pmid: 25531429