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P546 Psychiatric disorder, iron deficiency, active disease and female gender are independent risk factors for fatigue in patients with ulcerative colitis

B. Jonefjäll1, 2, M. Simrén1, 3, A. Lasson4, L. Öhman1, 5, H. Strid*1, 4

1Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden, 2Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden, 3University of Gothenburg Centre for Person-Centreed Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 4Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden, 5Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Department of Microbiology and Immunology, Gothenburg, Sweden

Background

Patients with inflammatory bowel disease often report high levels of fatigue. Fatigue has been correlated with disease activity, perceived stress, quality of sleep, and female gender. Previous studies report no correlation between fatigue and iron deficiency. Our aim was to investigate prevalence and risk factors for fatigue in patients with ulcerative colitis.

Methods

Patients with ulcerative colitis (UC) were classified with active disease (n = 133) or deep remission (n = 155). The criteria for deep remission were total Mayo score < 3 (sub-score for endoscopy, rectal bleeding, and PGA = 0) and no flare within 3 months. Flexible sigmoidoscopy was performed in patients with normal rectal mucosa and calprotectin >200 μg/g. Anaemia was defined as haemoglobin < 12.0 g/dL (Female) or <13.0 g/dL (Male), and iron deficiency as ferritin < 30 μg/L or ferritin 30–100 μg/L with elevated transferrinreceptor and/or transferrinsaturation < 16% (< 20% in presence of elevated CRP) in patients with active disease or patients in remission with elevated CRP. Questionnaires were used to assess fatigue (Multiple Fatigue Inventory [MFI]), psychiatric disorder (Hospital Anxiety and Depression scale [HAD]), and quality of life (Inflammatory Bowel Disease Questionnaire [IBDQ]). Levels of calprotectin in stool and CRP and cytokines (IL-6, IL-17, and TNF-α) in serum were analysed.

Results

The prevalence of high fatigue (MFI general fatigue ≥ 13) in UC patients with active disease was 52% compared with 26% in UC patients in deep remission (p < 0.001). UC patients with active disease had higher scores on all MFI domains compared with patients in deep remission (p < 0.01). It was more prevalent with female gender and iron deficiency in patients with high fatigue, and these patients had higher disease activity and reported higher levels of anxiety, depression, and decreased quality of life (Table 1). Logistic regression analysis identified independent risk factors for high fatigue as probable psychiatric disorder (HAD total ≥ 13), OR 6.1 (3.1–12.2), p < 0.001; iron deficiency, OR 2.5 (1.2–5.1), p = 0.02; active disease, OR 2.2 (1.2–3.9), p = 0.01; and female gender, OR 2.1 (1.1–3.7), p = 0.02, (R2 = 0.32). There was no difference in inflammatory markers comparing patients in deep remission with and without high fatigue.

UC high fatigue (n = 116)UC low 
fatigue (n = 172)p-value
Years of age, mean (min-ax)39 (19–69)44 (18–73)< 0.01
Female gender, n (%)61 (52)55 (32)< 0.01
Mayo score, mean (SD)3.4 (3.1)1.7 (2.5)< 0.001
Calprotectin (μg/g), median (IQR)112 (27–663)53 (17–190)< 0.01
Anaemia, n (%)7 (6)6 (3)0.39
Iron deficiency, n (%)32 (32)12 (19)< 0.001
HAD total, mean (SD)12.2 (6.9)4.9 (4.5)< 0.001
IBDQ, mean (SD)156 (31)196 (21)< 0.001

Conclusion

Psychiatric disorder, iron deficiency, and active disease are independent risk factors for fatigue in patients with ulcerative colitis. These factors should be investigated and appropriately treated in patients with ulcerative colitis suffering from fatigue.