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P542. Correlates of IBD fatigue: a meta-analysis and systematic review

I. Nathan1, K.C. Fragkos1, A. Forbes1, 1University College London, Centre for Gastroenterology and Nutrition, London, United Kingdom

Background

Fatigue is a problematic symptom for IBD patients and its management can be challenging. The aim of the present study is to assess the association of fatigue and disease activity, as well as other factors, using a systematic literature review and meta-analysis.

Methods

A systematic literature review was performed in PubMed and EMBASE. All studies reporting correlation coefficients (CCs) of fatigue with disease activity were included. A random-effects model was employed to produce a pooled estimate of CCs, which was the effect size in the current analysis. Fisher's Z transformation of the CCs was utilised for the analysis. Publication bias was assessed with funnel plots and Egger's test. All computations were executed with Stata 10.0 and MetaWin.

Results

Our search strategy revealed 1266 studies out of which only 23 were eligible for inclusion (total sample size = 5980). Fatigue was strongly correlated with IBD disease activity (pooled CC 0.386; 95% CI 0.335 to 0.435, range 0.165 to 0.540). Although there was no publication bias (failsafe N = 958), there was moderate heterogeneity (Q = 33.74, df = 14, p = 0.002; I2 = 58.5%). Subgroup analysis showed a relationship between the correlation of fatigue and disease activity with population group (adult, paediatric). Meta regression with percentage of males and mean age did not suggest that either were significant moderators of the particular correlation coefficient. Fatigue was also strongly correlated with quality of life (pooled CC −0.534; 95% CI −0.636 to −0.414), psychological distress (pooled CC 0.515; 95% CI 0.412 to 0.606) and daytime sleepiness (pooled CC 0.400; 95% CI 0.32 to 0.471), and was moderately correlated with anaemia (pooled CC 0.167; 95% CI 0.104 to 0.231) and social and functional impairment (pooled CC 0.288 95% CI 0.133 to 0.424). Heterogeneity was present in all analyses (p < 0.05), except for the meta-analyses with anaemia, daytime sleepiness and social and functional impairment. Publication bias was more probable in the secondary factors compared with disease activity analyses in the initial correlation.

Conclusion

Fatigue in individuals with IBD correlates with quality of life, psychological distress, daytime sleepiness, disease activity, anaemia and social and functional impairment. This is the first meta-analysis of IBD fatigue and clearly highlights the multidimensional nature of this symptom.

This study has received funding from the Big Lottery Fund and is commissioned by Crohn's and Colitis UK.