Abstract t #1446 The Fatigue of Chronic Liver Disease is Associated with Altered Circadian Rhythm of Cortisol – Michele M. Tana, et al.
Fatigue is a common complaint for patients with liver disease, and researchers don’t completely know the cause of this. Scientists noticed that patients with chronic liver disease (CLD) had various signs and symptoms associated with circadian rhythms, also known as sleep-wake patterns. Were these problems caused by the brain’s master clock or in the liver’s clock?
This prospective study enrolled 12 subjects with CLD; six had fatigue and six did not. They took blood samples at various times while evaluating fatigue level.
Conclusion: Looking at various factors, they found that the circadian rhythms of cortisol were “significantly disrupted in CLD patients with fatigue.”The researchers recommend more studies examining the hypothalamic-pituitary-adrenal axis in the brain to help us find ways to improve fatigue in CLD patients.
Editorial Comments: This study only looked at the broader picture of liver disease. People who have hepatitis C may have additional factors that contribute to fatigue.
Lucinda K. Porter, RN, is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com
Fatigue & Hepatitis C: A Focus Group Study—S K Afdhal et. al
Up to 97% of people with hepatitis C report fatigue with 88% reporting some form of fatigue every day. The current study sought to understand the degree of fatigue by a qualitative—describing the fatigue—focus group approach. The study enrolled patients who would describe their experiences of fatigue and how it influenced their lives. There were three focus groups with 3-7 hepatitis C patients in each group—a total of 16 patients were enrolled. The study was approved by Institutional Review Board—this is standard practice in clinical trials. The patient characteristics were ~58 years old, 56% female and 50% Caucasian. The patients were asked to focus on their experiences of fatigue and to describe their symptoms. Their responses were audio recorded and analyzed by two independent researchers.
Conclusion: The researchers broke down the experiences into two first measurements of fatigue: capacity and engagement. The subcategories (italics) with patient responses for examples.
Capacity: access: “e.g. I don’t have a lack of energy; I have an inability to access that energy. It’s like a car that won’t start,” depletion: “e.g. If I got up today and worked a whole eight hour day, I wouldn’t make it tomorrow.”), and restoration: (e.g. “It’s like a car running out of gas. Sooner or later, you better stop and get the fill up or you’re just going to be dead on the side of the road”).
Engagement: initiation:“(e.g. “My mental self can see myself getting up but my physical self can’t do it. Frustrating because I want to.”) and personal satisfaction: (e.g. “Affects activity schedule because I have to balance activity and can’t do all the things I want to do”).”
The authors concluded that these domains need to be incorporated to validate future studies of fatigue in people infected with chronic hepatitis C.
Editorial Comments: Fatigue is very hard to measure since it is self-reported. To my knowledge, few self-reported scales accurately measure fatigue. I well remember fatigue when I had chronic hepatitis C. The descriptions reported by patients ring true to me. I will be interested if others with hepatitis C feel the same.