Yilmaz Yusuf, Keklikkiran Caglayan, Racila Andrei, Stepanova Maria, Younossi Zobair M
The Global NASH Council, Center for Outcomes Research in Liver Diseases, Wahington, District of Columbia, USA.
Institute of Gastroenterology, Marmara University, İstanbul, Türkiye.
Clin Transl Gastroenterol. 2025 Apr 28;16(6):e00844. doi: 10.14309/ctg.0000000000000844. eCollection 2025 Jun 1.
Despite being underappreciated, pruritus and fatigue are not uncommon in metabolic dysfunction-associated steatotic liver disease (MASLD). In this prospective registry-based study, we sought to evaluate the prevalence, predictors, and impact of these symptoms on patient-reported outcomes (PROs) in patients with MASLD from Türkiye, a country with one of the highest burdens of MASLD globally.
A total of 1,874 Turkish patients from the Global Liver Registry were included. Significant pruritus and fatigue were defined using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis and the Functional Assessment of Chronic Illness Therapy-Fatigue, respectively. PROs were assessed using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Impairment: Specific Health Problem questionnaire.
The prevalence of significant pruritus and fatigue was 37% and 33%, respectively. Both symptoms were significantly associated with female sex, type 2 diabetes, depression, abdominal pain, and lack of regular exercise. Patients with these symptoms had significantly worse PROs, with impairments up to 31% (all P < 0.0001). Over 1-2 years, symptoms persisted in 47%-52% of patients with baseline pruritus and 33%-39% with baseline fatigue. Independent predictors of a higher likelihood of resolution of pruritus included the absence of fatigue at baseline and the lack of abdominal pain, with odds ratios of 0.36 (95% confidence interval: 0.22-0.59) and 0.60 (95% confidence interval: 0.39-0.91), respectively (both P < 0.05).
Pruritus and fatigue are common in MASLD, significantly impairing PROs and often persisting over time. Regular assessment and management are essential to improve patients' well-being and functioning.
尽管未得到充分重视，但瘙痒和疲劳在代谢功能障碍相关脂肪性肝病（MASLD）中并不罕见。在这项基于前瞻性登记的研究中，我们试图评估这些症状在来自土耳其的MASLD患者中的患病率、预测因素及其对患者报告结局（PRO）的影响。土耳其是全球MASLD负担最高的国家之一。
纳入了全球肝脏登记处的1874名土耳其患者。分别使用慢性肝病问卷-非酒精性脂肪性肝炎和慢性病治疗功能评估-疲劳量表来定义严重瘙痒和疲劳。使用慢性肝病问卷-非酒精性脂肪性肝炎、慢性病治疗功能评估-疲劳量表以及工作效率和活动障碍：特定健康问题问卷来评估PRO。
严重瘙痒和疲劳的患病率分别为37%和33%。这两种症状均与女性、2型糖尿病、抑郁症、腹痛以及缺乏规律运动显著相关。有这些症状的患者PRO明显更差，损害高达31%（所有P<0.0001）。在1至2年的时间里，基线时有瘙痒症状的患者中47%-52%症状持续存在，基线时有疲劳症状的患者中33%-39%症状持续存在。瘙痒症状缓解可能性较高的独立预测因素包括基线时无疲劳症状以及无腹痛，优势比分别为0.36（95%置信区间：0.22-0.59）和0.60（95%置信区间：0.39-0.91）（均P<0.05）。
瘙痒和疲劳在MASLD中很常见，会显著损害PRO，且往往会持续存在。定期评估和管理对于改善患者的健康状况和功能至关重要。
