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OP22 Factors independently associated with fatigue in IBD: Results from the baseline dataset of the PREdiCCt study

Derikx, L.(1,2);Siakavellas, S.(2);Derr, L.(2);Williams, L.(2);Nikolas, P.(2);Jenkinson, P.(2);Lucaciu, L.(2);Constantine-Cooke, N.(3);Covil, K.(2);Murdoch, L.(2);Jones, G.R.(2,4);Lees, C.(2,5)

(1)Radboud University Nijmegen Medical Centre, Inflammatory Bowel Disease Centre- Department of Gastroenterology and Hepatology- Route 455, Nijmegen, The Netherlands;(2)Western General Hospital, The Edinburgh IBD Unit, Edinburgh, United Kingdom;(3)University of Edinburgh- Western General Hospital, MRC Human Genetics Unit- Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom;(4)University of Edinburgh, Centre for Inflammation Research- The Queen's Medical Research Institute, Edinburgh, United Kingdom;(5)University of Edinburgh- Western General Hospital, Centre for Genomics and Experimental Medicine- Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom PREdiCCt Study Writing Group

Background

Fatigue is one of the most common symptoms in IBD resulting in decreased quality of life, impaired work productivity, and higher societal costs. However, little is known about its etiology and pathophysiology. We aimed to estimate the prevalence of fatigue and to identify predictive factors for fatigue.

Methods

The PREdiCCt study (https://www.predicct.co.uk) is the largest prospective study of the causes of IBD flare. 2629 patients in clinical remission were recruited from 48 UK sites. 1946 (74%) patients completed the baseline questionnaires. We assessed the prevalence of fatigue at baseline using a single item from the IBD Control questionnaire. To identify predictors for fatigue, we performed univariable and multivariable analyses including demographic, biochemical, environmental and psychosocial factors such as anxiety and depression [HADS], sleep quality [PSQI] and physical exercise [GPAQ]).

Results

759/1919 IBD patients in clinical remission (39.6%) reported fatigue in the past 2 weeks, while 1034 patients (53.9%) did not report fatigue. Patients who reported fatigue were more frequently female, had more frequently CD, and were more frequently smokers (Table 1). Univariable comparisons showed higher inflammatory markers in the fatigued group, with fewer patients in clinical remission. Multivariable analyses identified female sex (OR 2.4), CRP>5 (OR 2.1), bad sleep quality (OR 2.5), anxiety (OR 1.8) and depression (OR 6.2) as independent factors associated with fatigue (Table 2).

Table 1

Variable (n [%], or median [IQR])Often lack energy – yes(n=759)Often lack energy – no(n=1034)P-value
Female sex504 (66.4)508 (49.1)<0.001
Current smoker57 (8.9)45 (4.9)0.002
IBD type (CD)431 (57.2)492 (48.0)<0.001
Haemoglobin (g/L)136 (127-145)140 (131-148)<0.001
White cell count (x10^9/L)6.3 (5.3-7.8)6.0 (5.0-7.2)<0.001
CRP <5 mg/L360 (62.8)588 (76.5)<0.001
Ferritin (ug/L)56 (27-106.5)66 (36-116)0.011
Folate (ug/L)6.5 (4.3-10.5)7.3 (5.0-10.9)0.011
Clinical remission (HBI<4, pMayo<2)287 (71.8)482 (82.7)<0.001
Depression (HADS>9)224 (30.0)49 (4.8)<0.001
Anxiety (HADS>9)336 (45.0)165 (16.2)<0.001
Physical activity (GPAQ<600)207 (27.6)193 (18.8)<0.001
Sleep quality (PSQI>5)633 (90.2)693 (69.9)<0.001

Table 2

VariableOR95% CIP-value
Female sex2.41.5-3.8<0.001
CRP >5 mg/L2.11.3-3.50.004
Depression (HADS>9)6.22.9-13.3<0.001
Anxiety (HADS>9)1.81.1-3.00.031
Sleep quality (PSQI>5)2.51.4-4.60.002

Conclusion

We show the significant burden of fatigue in IBD patients and describe putative causes which demonstrate both the impact of residual gut inflammation and the relationship between fatigue and psychological well-being. The impact of environmental and dietary factors on fatigue is being further investigated with ongoing longitudinal data collection in the PREdiCCt study.

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