High Prevalence of Pruritus, Fatigue, and Sleep Disorders in MASLD Negatively Affects Health-related Quality of Life and Work Productivity
Zobair M. Younossi, Yusuf Yilmaz, Ming-Lung Yu, Mohamed El-Kassas, Marlen Castellanos Fernandez, Yuichiro Eguchi, George V. Papatheodoridis, Vincent Wai-Sun Wong, Ajay K. Duseja, Ashwani K. Singal, Saeed S. Hamid, Elisabetta Bugianesi, Vasily A. Isakov, Manuel Romero Gomez, Wah-Kheong Chan, Khalid Alswat, Jian-Gao Fan, Stuart C. Gordon, Stuart K. Roberts, Jacob George, Nahum Méndez-Sánchez, Caglayan Keklikkiran, Eugen Tcaciuc, Andrei Racila, Brian Lam, Linda Henry, Andrei Racila, Maria Stepanova, Saleh A. Alqahtani,Background:
Metabolic dysfunction–associated steatotic liver disease (MASLD) is associated with health-related quality of life (HRQL) impairment, which can be exacerbated by pruritus, fatigue, and/or sleep disorders. We assessed the prevalence of significant pruritus, fatigue, and sleep disorders in patients with MASLD and evaluated their association with HRQL and work productivity loss.
Methods:
Patients with MASLD were prospectively enrolled into the Global NAFLD/MASLD Registry. Clinical and HRQL (per CLDQ-MASH and WPAI:SHP questionnaires) data were analyzed according to the presence of significant pruritus, significant fatigue, and sleep disorders.
Results:
A total of 8034 patients with MASLD from 39 countries (age 54±12 years, 46% male, 50% type 2 diabetes, 39% advanced fibrosis) were included. At baseline, 25% reported significant pruritus, 35% significant fatigue, and 34% sleep disorders, and 10% had all 3 symptoms. Patients with fatigue, pruritus, or sleep disorder were more likely to be female, have higher BMI, more metabolic comorbidities, and greater psychiatric burden. At 1-year follow-up, over half of the patients with baseline symptoms continued to experience them, and 14% to 18% developed de novo symptoms. Multivariate analyses showed that significant pruritus and sleep disorders each independently predicted fatigue [OR=9.51 (8.0-11.3)] when both conditions were present. Pruritus was a strong predictor of sleep disorders [OR=2.90 (2.6-3.3)]. All 3 conditions, especially fatigue, were independently associated with significantly impaired HRQL and work productivity loss.
Conclusion:
Clinically significant fatigue, pruritus, and sleep disorders are common in MASLD, having a negative impact on HRQL and a substantial economic burden.