Unraveling the connection: Fatigue in chronic liver disease

Living with Chronic Liver Disease (CLD) and feeling exhausted all the time?

Fatigue is defined as extreme exhaustion and failure to initiate or sustain physical activity1.

It is one of the most common symptoms in CLD with up to 50% of patients presenting with clinically significant fatigue1.

How common is fatigue in liver diseases?2:


Alcoholic liver disease (ALD)


Non-alcoholic fatty liver disease (NAFLD)


Hepatitis C (HCV)


Primary biliary cholangitis (PBC)


Hepatitis B (HCB)


Autoimmune hepatitis


Drug-induced liver injury (DILI)


Primary sclerosing cholangitis (PSC)

Prevalence of fatigue varies among different chronic liver diseases2

The severity of fatigue is not directly proportional to the severity of the disease2

Symptoms of fatigue in CLD 1-3:

Chronic liver disease-related fatigue is associated with mood shifts, sleep disturbance and mental health issues1.

Types of fatigue in CLD1

  • Central fatigue is the main reason for tiredness in the early stages of CLD2.
  • Central fatigue is also linked to mental health issues like depression and anxiety1.

Impact of fatigue in CLD on quality of life1


of patients believe it hinders their work performance.


of patients feel it disrupts their family time.


of patients say it affects their daily physical activities.

What causes fatigue in CLD patients?1,3,4

Liver : Brain Axis: The diseased liver communicates with the brain


Fatigue is the most common symptom in CLD.  The diseased liver disrupts neuralcommunications associated with motor function, reward and motivation behavior in the brain. It is also associated with sleep disturbance and mental health issues.  Therefore, significantly impacts patient’s quality of life.


1. Swain MG, Jones DEJ. Fatigue in chronic liver disease: New insights and therapeutic approaches. Liver Int. Jan2019;39(1):6-19. doi:10.1111/liv.139192.

2. Kosnik A, Wojcicki M. Fatigue in chronic liver disease patients: prevalence, pathophysiology, and management. Prz Gastroenterol. 2022;17(1):21-27. doi:10.5114/pg.2022.1145943.

3. Bhandari K, Kapoor D. Fatigue in Cirrhosis. J Clin Exp Hepatol. Mar-Apr 2022;12(2):617-624.doi:10.1016/j.jceh.2021.08.0284.

4. D’Mello C, Swain MG. Liver-brain inflammation axis. Am J Physiol Gastrointest Liver Physiol. Nov 2011;301(5):G749-61. doi:10.1152/ajpgi.00184.201

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