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Association between fatigue and decreased survival in primary biliary cirrhosis
  1. Claudia O Zein1,
  2. Arthur J McCullough2
  1. 1Division of Gastroenterology and Hepatology, University Hospitals of Cleveland, Cleveland, and Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
  2. 2Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to:
    Dr Claudia O Zein
    Division of Gastroenterology and Hepatology, Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard 111 E (W), Cleveland, Ohio 44106, USA;Claudia.zein{at}

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We read with interest the article by Jones and colleagues on the stability of fatigue severity in patients with primary biliary cirrhosis (PBC) over 4 years of follow-up (Gut 2006;55:536–41). The authors reported that, in their patient cohort, a high fatigue score predicted subsequent decreased survival.

Fatigue is frequent in patients with PBC, and it is known to have a negative impact on quality of life in this population.1–3 An established association between the presence of a high fatigue score at presentation and a significantly higher likelihood of death would have important implications. To date, recognised variables associated with prognosis in patients with PBC include age, certain markers of liver function and scores based on these.3 A lack of association between fatigue and markers of liver disease severity in PBC has been demonstrated.4

We have investigated the relationship between the presence of fatigue at presentation and subsequent survival in PBC. A cohort of 241 patients with PBC seen at four major teaching hospitals in the city of Cleveland between 1990 and 2005 who had not undergone liver transplantation were identified. Data obtained at the time of the first evaluation leading to the diagnosis of PBC were collected. Self-reported fatigue at the time of initial evaluation was recorded. Medical records were reviewed to determine outcomes up to 2006. Mean (SD) follow-up time was 5.4 (0.3) years (range 1–16). The log rank test was used to compare survival following diagnosis in patients who reported fatigue at presentation compared with those who did not. Laboratory, clinical and histological characteristics at presentation were compared between patients who survived and those who died …

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