Abstract
BackgroundPruritus is a common symptom seen in patients with chronic liver disease. However, frequency and severity of pruritus in patients with chronic liver disease is unclear. We investigated frequency, severity and predictive factors of pruritus in these patients from a large cohort.MethodsA total of 2477 patients with chronic liver disease without allergies or skin diseases were investigated for itch frequency and severity. Itch severity was self-assessed using pruritus scores using the numerical rating scale (NRS). Multivariate regression analysis was performed to identify factors associated with pruritus. Serum autotaxin levels were measured in patients with primary biliary cholangitis (PBC), and the relationship to liver fibrosis and pruritus was analyzed.ResultsThe frequency of pruritus in patients with chronic liver disease was significantly higher than in subjects without liver disease (29.8 and 16.2%, respectively, P < 0.001). NRS was high in patients with chronic liver disease, especially in those with PBC, as is generally expected. Multivariate analysis identified lower albumin, higher eosinophil count, and etiology of PBC as independent factors associated with severe pruritus (≥5 points of NRS). In patients with PBC, serum autotaxin levels were significantly correlated with liver fibrosis markers such as platelet count and liver stiffness, and hepatobiliary enzymes such as total bilirubin, aspartate aminotransferase and alkaline phosphatase. However, no significant correlations between serum autotaxin levels and frequency and severity of pruritus were observed in patients with PBC.ConclusionThe frequency of pruritus was high in patients with chronic liver disease. Reduction of liver function is associated with severe pruritus based on the large number of patients with chronic liver disease. Serum autotaxin is useful for assessing liver fibrosis and severity of cholangitis; however, it is not a predictive marker for severe pruritus in patients with PBC.
Highlights
IntroductionFrequency and severity of pruritus in patients with chronic liver disease is unclear
Pruritus is a common symptom seen in patients with chronic liver disease
Factors associated with pruritus We analyzed factors associated with severe pruritus, which we define as numerical rating scale (NRS) ≥5
Summary
Frequency and severity of pruritus in patients with chronic liver disease is unclear. Pruritus is defined as an unpleasant sensation that triggers the need to scratch [1]. It develops in association with chronic liver diseases, including hepatitis, liver cirrhosis, primary biliary cholangitis (PBC) and obstructive jaundice. Pruritus associated with chronic liver disease tends to be generalized and is not relieved by scratching [2], with marked negative impact on the quality of life of the patients [3]. Factors associated with severe pruritus in patients with chronic liver disease are not well known. Establishment of useful prediction markers for pruritus in chronic liver disease is required
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