According to a post hoc analysis of two-phase III trials published in Clinical Gastroenterology and Hepatology patients with nonalcoholic steatohepatitis (NASH)-related severe fibrosis and cirrhosis who suffered from acute fatigue had a higher risk of developing adverse clinical events.802 of the 1679 NASH patients with fibrosis had bridging fibrosis (F3), while 877 had compensated cirrhosis (F4).

Lower baseline scores on the chronic liver disease questionnaire (CLDQ)-NASH, indicated worse fatigue. Bridging fibrosis (F3) showed an adjusted hazard ratio (aHR) of 0.85 per 1 point increase (95% CI 0.75-0.96, P=0.0088), while a hazard ratio (HR) of 0.67 per 1 point (95% CI 0.53-0.85, P=0.0014) was seen in compensated cirrhosis (F4) group.

After following up for 16 months, 15% of NASH patients with F3 developed liver-related events, with 95% progressing to cirrhosis and the rest experiencing hepatic decompensation. 3.5% of patients with NASH F4 experienced episodes of hepatic decompensation. 42% of these patients suffered from ascites, 23% had hepatic encephalopathy, 13% had hepatocellular carcinoma (HCC), 13% had portal hypertension-related upper GI hemorrhage, and 3% had to undergo a liver transplant.

The mean baseline CLDQ-NASH fatigue score was 4.8 (range 1-7) for F3, 4.6 (range 1-7) for F4 patients and 3.7(range 1-7) for patients who decompensated in follow-up.

Thus it was concluded that the lower fatigue score was associated with a higher risk of adverse clinical events in patients with NASH-related advanced fibrosis and cirrhosis. (MedPage Today May 9, 2022), Clin Gastroenterol Hepatol 2022; DOI: 10.1016/j.cgh.2022.04.023.