Abstract
INTRODUCTION: Despite being underappreciated, pruritus and fatigue are not uncommon in metabolic dysfunction-associated steatotic liver disease (MASLD). In this prospective registry-based study, we sought to evaluate the prevalence, predictors, and impact of these symptoms on patient-reported outcomes (PROs) in patients with MASLD from Türkiye, a country with one of the highest burdens of MASLD globally. METHODS: A total of 1,874 Turkish patients from the Global Liver Registry were included. Significant pruritus and fatigue were defined using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis and the Functional Assessment of Chronic Illness Therapy-Fatigue, respectively. PROs were assessed using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Impairment: Specific Health Problem questionnaire. RESULTS: The prevalence of significant pruritus and fatigue was 37% and 33%, respectively. Both symptoms were significantly associated with female sex, type 2 diabetes, depression, abdominal pain, and lack of regular exercise. Patients with these symptoms had significantly worse PROs, with impairments up to 31% (all P < 0.0001). Over 1-2 years, symptoms persisted in 47%-52% of patients with baseline pruritus and 33%-39% with baseline fatigue. Independent predictors of a higher likelihood of resolution of pruritus included the absence of fatigue at baseline and the lack of abdominal pain, with odds ratios of 0.36 (95% confidence interval: 0.22-0.59) and 0.60 (95% confidence interval: 0.39-0.91), respectively (both P < 0.05). DISCUSSION: Pruritus and fatigue are common in MASLD, significantly impairing PROs and often persisting over time. Regular assessment and management are essential to improve patients' well-being and functioning.