Published online Mar 21, 2021. doi: 10.3748/wjg.v27.i11.1076
Peer-review started: December 28, 2020
First decision: January 9, 2021
Revised: January 14, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: March 21, 2021
Fatigue is frequent and disabling in patients with inflammatory bowel disease (IBD), but the prevalence and risk factors for fatigue in Chinese patients with IBD are unknown. In addition, neither the relationship between fatigue and quality of life (QoL) nor the relationship between fatigue and work productivity (WP) has been reported in Chinese IBD patients.
Fatigue is a very common but relatively neglected problem in patients with IBD. The prevalence rate of IBD in China is the highest in Asia, but there is little research on fatigue in patients with IBD. Neither the relationship between fatigue and QoL nor the relationship between fatigue and WP in Chinese IBD patients has been reported.
Our primary aim was to investigate the prevalence of fatigue related to IBD in Eastern China, and to identify the risk factors associated with fatigue. Our second objective was to assess the impact of fatigue on QoL and to evaluate the relationship between fatigue and WP.
A cross-sectional study was conducted in a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China. Clinical data of patients were collected, and disease activity was evaluated. Blood samples were analyzed to assess anemia, albumin, and inflammation. Fatigue was assessed using the multidimensional fatigue inventory. QoL and WP were measured using the short inflammatory bowel disease questionnaire and the work productivity and activity impairment general health questionnaire, respectively. The patients also completed assessments of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder 7-item Scale).
A total of 311 IBD patients were enrolled in this study, 168 of whom were Crohn's disease patients, and 143 of whom were ulcerative colitis patients. The prevalence of fatigue in patients with IBD was 60.77%, including 71.88% in the active stage and 49.01% in the remission stage. The median fatigue total score was 43 (IQR: 33-59) in the full study population. In a univariate logistic regression analysis, factors such as disease activity, depression, anxiety, anemia, and IBD-related surgery were individually related to a significantly increased risk of fatigue in IBD patients. Multivariate logistic regression analysis indicated that depression [odds ratio (OR) = 8.078, 95% confidence interval (CI): 4.113-15.865], anxiety (OR = 2.373, 95%CI: 1.100-5.119), anemia (OR = 2.498, 95%CI: 1.290-4.834), and IBD-related surgery (OR = 2.035, 95%CI: 1.084-3.819) were related to fatigue in IBD patients. There was a negative correlation between fatigue and QoL (r = -0.831; P < 0.0001) but a positive correlation between fatigue and WP loss.
The prevalence of fatigue in IBD patients in Eastern China is remarkably high even in clinical remission. Factors such as depression, anxiety, anemia, and IBD-related surgery are major risk factors for fatigue in IBD patients. In addition, fatigue has a negative impact on QoL and is positively correlated with WP loss.
The prevalence of fatigue is considerably high in IBD patients in Eastern China even in clinical remission. In addition, fatigue reduces the QoL of IBD patients in Eastern China and damages WP. Clinicians and patients should be aware of and prevent the incidence of fatigue. The future research direction is to conduct a multicenter study to evaluate the incidence of fatigue in Chinses IBD patients, and more accurately screen out the risk factors leading to the incidence of fatigue in Chinese IBD patients, to effectively prevent the incidence of fatigue.