Burden of fatigue in compensated chronic liver disease: findings from the multinational a:GAP Study

  1. Gourdas Choudhuri
  2. Gamar Akhundova-Unadkat
  3. Nivantha Naidoo
  4. Mauricio Morales-Castillo
  5. Xavier Guillaume
  6. Ruben G. Duijnhoven
  7. Azadeh Safaei
  8. Mark G. Swain
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Abstract

Background & Aims

Fatigue is a central symptom of chronic liver disease (CLD), substantially impacting health-related quality of life (HRQoL). This study aimed to further understand CLD symptomatology, including fatigue, and its impact on HRQoL from a patient perspective.

Methods

A bbott G lobal A ssessment of P atients unmet needs (aGAP) was a multinational, cross-sectional survey in adults with compensated CLD in China, India and Mexico, conducted between July and November 2024. Adult participants who self-reported that they had physician-diagnosed CLD and were experiencing fatigue completed a quantitative survey to assess symptom burden and included three HRQoL patient-reported outcome (PRO) questionnaires (Patient-Reported Outcomes Measurement Information System [PROMIS]-29+2, Work Productivity and Activity Impairment – Specific Health Problem version 2.0 [WPAI: SHP], Multidimensional Fatigue Inventory [MFI]).

Results

Overall, 505 participants (China: 200; Mexico: 105; India: 200) completed the study. Participants reported that their CLD-related fatigue sometimes, often or always affected their self-esteem/confidence (45.1%) and ability to maintain or acquire new employment (38.6%). Most participants reported moderate (51.3%) or serious (26.9%) fatigue, with 33.5% experiencing fatigue every day or almost every day. Many participants felt their social life was negatively impacted by their fatigue (47.3%) and that there were related financial difficulties (53.9%). Use of validated PRO tools demonstrated severe fatigue (MFI: overall mean [SD] 13.9 [3.4] general fatigue and 13.4 [3.6] physical fatigue) as well as substantial levels of work and activity impairment (WPAI: SHP overall mean [SD] 53.0 [26.4]) and high levels of anxiety, pain interference, depression and sleep interference (PROMIS T-scores ≥54).

Conclusions

Fatigue has a substantial impact on HRQoL among adults with CLD across several countries, highlighting a global unmet need for targeted interventions to effectively identify and manage the condition.

Highlights

  • In this multinational survey of 505 adults with compensated CLD, one-third experienced fatigue daily or almost daily, with substantial impact on social function, employment and HRQoL.

  • Fatigue co-occurred with elevated anxiety, depression, pain interference and sleep disturbance (PROMIS T-scores ≥54), along with pronounced work and activity impairment (WPAI:SHP 53.0).

  • Cross-country (India, China, Mexico) differences in fatigue perception and support largely reflected sociodemographic and healthcare-system factors rather than biological variation in CLD.

  • These findings demonstrate a global unmet need for systematic assessment and targeted management of fatigue in routine CLD care.

Article activity feed

  1. Version published to 10.64898/2026.08.28.26361618 on medRxiv