Fatigue assessment in Egyptian patients with hepatitis C virus-related chronic liver disease: Single center study

Table 1 Socio-demographic and clinical data of the participants (n = 300), n (%)/mean ± SD/median (interquartile range)

Variables
Age (years)	57.3 ± 10.6, 59.0 (15.0)
< 45 years	66 (22.0)
45-59 years	110 (36.7)
≥ 60 years	124 (41.3)
Gender
Male	190 (63.3)
Female	110 (36.7)
Marital status
Single	6 (2.0)
Married	258 (86.0)
Divorced	30 (10.0)
Widow	6 (2.0)
Level of education
Illiterate and primary education	96 (32.0)
Secondary education	116 (38.7)
Higher education	88 (29.3)
Residence
Rural	168 (56.0)
Urban	132 (44.0)
Smoking
No	216 (72.0)
Yes	58 (19.3)
Ex smoker	26 (8.7)
Co-morbidities (yes)1	150 (50.0)
Clinical stage
Chronic liver disease	52 (17.3)
Compensated	174 (58.0)
Decompensated	72 (24.0)
Child score (n = 248)
A	170 (68.5)
B	28 (11.3)
C	50 (20.2)
Ascites (yes)	79 (26.3)
History of GIT bleeding (yes)	56 (18.7)
History of hepatic encephalopathy (yes)	51 (17)
HCV infection duration
< 10 years	159 (53.0)
≥ 10 years	141 (47.0)
Antiviral treatment (yes)	262 (87.3)
The duration of last dose of antiviral treatment (n = 262)
< 1 year	6 (2.0)
≥ 1 year	256 (97.7)
Antiviral treatment response (n = 262)
Response	247 (94.3)
Failure	15 (5.7)
MELD score	9.2 (3.1)
ALT	29.0 (19.3)
AST	32.0 (24.8)
Total bilirubin (mg/dL)	1.0 (0.6)
Albumin (g/dL)	3.8 (0.7)
Creatinine (mg/dL)	0.90 (0.3)
INR	1.1 (0.1)
Platelet	155.0 (140.0)

¹Comorbidities (including diabetes mellitus and hypertension), hepatitis C virus.

MELD: Model for end-stage liver disease; GIT bleeding: Gastrointestinal tract bleeding; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; HCV: Hepatitis C virus.

Table 2 Multidimensional fatigue inventory total score and subscale scores in chronic hepatitis C virus disease populations

MFI-20	mean ± SD/median, interquartile range
General fatigue	12.3 ± 1.13/12.0, 1.0
Physical fatigue	12.9 ± 1.7/13.0, 2.0
Reduced activity	12.6 ± 1.4/13.0, 2.0
Reduced motivation	12.9 ± 1.5/13.0, 2.0
Mental fatigue	13.2 ± 1.1/12.0, 1.0
Total MFI score	62.5 ± 3.8/63.0, 4.0

MFI: Multidimensional fatigue inventory.

Table 3 Factors associated with significant fatigue among chronic hepatitis C patients, n (%)

Variables	Non-fatigue group (n = 218)	Significant fatigue group (n = 82)	P value
Age groups			0.081
< 45 years	49 (74.2)	17 (25.8)
45-59 years	87 (79.1)	23 (20.9)
≥ 60 years	82 (66.1)	42 (33.9)
Gender			0.274
Male	134 (70.5)	56 (29.5)
Female	84 (76.4)	26 (23.6)
Marital status			0.347
Single1	28 (66.7)	14 (33.3)
Married	190 (73.6)	68 (26.4)
Residence			0.039
Rural	130 (77.4)	38 (22.6)
Urban	88 (66.7)	44 (33.3)
Smoking			0.543
No	174 (71.9)	68 (28.1)
Yes	44 (75.9)	14 (24.1)
Co-morbidities (DM and/HTN)			0.195
No	114 (76.0)	36 (24.0)
Yes	104 (69.3)	46 (30.7)
Clinical stage			0.001
Chronic liver disease	43 (82.7)	9 (17.3)
Compensated liver disease	136 (78.2)	38 (21.8)
Decompensated liver disease	39 (52.7)	35 (47.3)
Child score (n = 248)			0.015
A	136 (80.0)	34 (20.0)
B	20 (71.4)	8 (28.6)
C	30 (60.0)	20 (40.0)
FIB-4 fibrosis classes			0.001
Low risk (FIB-4 < 1.45)	146 (80.7)	35 (19.3)
Intermediate risk (FIB from 1.45-3.25)	52 (28.8)	21 (28.8)
High risk (FIB-4 > 3.25)	20 (43.5)	26 (56.5)
MELD score			0.001
< 15	211 (78.1)	59 (21.9)
≥ 15	7 (23.3)	23 (76.7)
Ascites			0.001
No	173 (78.3)	48 (21.7)
Yes	45 (57.0)	34 (43.0)
History of GIT bleeding			0.026
No	184 (75.4)	60 (24.6)
Yes	34 (60.7)	22 (39.3)
History of hepatic encephalopathy			0.001
No	195 (78.3)	54 (21.7)
Yes	23 (45.1)	28 (54.9)
Antiviral treatment			0.003
No	20 (52.6)	18 (47.4)
Yes	198 (75.6)	64 (24.4)
The duration of last dose of antiviral treatment (n = 262)			0.033
< 1 year	2 (33.3)	4 (66.7)
≥ 1 year	196 (76.6)	60 (23.4)
Antiviral treatment response (n = 262)			0.059
Response	190 (76.9)	57 (23.1)
Failure	8 (53.3)	7 (46.7)
HCV infection duration2			0.001
< 10 years	138 (86.8)	21 (13.2)
≥ 10 years	80 (56.7)	61 (43.3)

¹Single includes individuals who are not currently married (single, divorced, widow).

²Hepatitis C virus infection duration categorized according to the median (< 10 years and ≥ 10 years).

DM: Diabetes mellitus; FIB-4: Fibrosis-4; HTN: Hypertension; HCV: Hepatitis C virus; MELD: Model for end-stage liver disease; GIT bleeding: Gastrointestinal tract bleeding.

Table 4 Univariate and multivariable regression analysis of risk factors for significant fatigue in chronic liver disease

Variables1	Univariate		Multivariate analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Age (< 45 years/≥ 45 years)	1.67 (0.822-3.44)	0.155
Gender (male/female)	1.35 (0.74-2.3)	0.275
Clinical stage of liver disease (chronic liver disease/compensated/decompensated)	3.4 (1.9-5.9)	0.001	3.3 (1.7-6.6)	0.001
Child score (Child A/Child B and C)	2.2 (1.2-4.1)	0.008
FIB-4 fibrosis classes (low risk/intermediate/high risk)	2.7 (1.6-4.5)	0.001	3.7 (1.7-7.8)	0.001
MELD score (< 15/≥ 15)	11.7 (4.8-28.7)	0.001
Ascites (no/yes)	1.6 (1.2-2.1)	0.001
History of GIT bleeding (no/yes)	1.4 (1.04-1.9)	0.028
History of hepatic encephalopathy (no/yes)	2.09 (1.5-2.87)	0.001
Antiviral treatment (no/yes)	2.7 (1.3-5.5)	0.004
The duration of last dose of antiviral treatment (n = 262) (< 1 year/≥ 1 year)	6.5 (1.5-36.5)	0.033	8.6 (1.27-58.3)	0.027
Antiviral treatment response (n = 262) (response/failure)	2.9 (1.04-8.3)	0.047
HCV infection duration (< 10 years/≥ 10 years)	1.19 (1.12-1.22)	0.003	1.2 (1.13-1.34)	0.001

¹The following variables (age, gender, and previous antiviral treatment, model for end-stage liver disease score and antiviral treatment) response were removed from the final model. Correlated variables also excluded from multivariate model. Hepatitis C virus infection duration categorized according to the median (< 10 years and ≥ 10 years).

OR: Odds ratio; CI: Confidence interval; HCV: Hepatitis C virus; MELD: Model for end-stage liver disease; GIT bleeding: Gastrointestinal tract bleeding; FIB-4: Fibrosis-4; MELD: Model for end-stage liver disease.