Psychological and hematological factors associated with fatigue in patients with Crohn’s disease receiving pharmacological treatment

BACKGROUND Fatigue is debilitating and costly for patients with Crohn’s disease (CD) and the healthcare system. Thus, as there are no well-established therapies for fatigue in patients with CD, it is essential to investigate its risk factors and collaborate to prevent or reduce its burden. AIM To evaluate the variables associated with fatigue in outpatients with CD receiving pharmacological treatment. METHODS It is an observational study. Data, including sociodemographic information, inflammatory bowel disease fatigue scores, visual analog scale scores, Depression Anxiety Stress Scale-21 scores, insomnia assessment results, and laboratory test results, were collected. Statistical analyses included Student’s t tests, logistic and linear regressions, and receiver operating characteristic curve analysis, with a P value of < 0.05 indicating statistical significance. RESULTS One hundred patients were included (77% presented with fatigue). In the linear regression analysis, symptoms of depression, anxiety, stress, and insomnia were simultaneously included as predictors of fatigue. Although the model was statistically significant (adjusted R 2 = 0.128; P = 0.002), no single symptom was significantly associated. A composite score (0-4) was developed by summing the scores of the 4 symptoms, which were coded dichotomously (odds ratio = 2.60; 95% confidence interval: 1.61-4.83; P < 0.001). The composite score showed good discriminative capacity (area under the curve = 0.775). Patients with fatigue had higher total leukocyte (P = 0.034) and segmented neutrophil (P = 0.017) counts and lower lymphocyte (P = 0.019) and eosinophil (P = 0.036) counts. Effect sizes ranged from moderate to high (Cohen’s d 0.39-0.61), indicating that fatigue may be associated with a leukocyte pattern consistent with relative neutrophilia and lymphopenia. CONCLUSION Fatigue is associated with psychological symptoms, a sedentary lifestyle, and alterations in leukocyte subpopulations. Assessments incorporating composite symptom scales and hematological parameters may be practical and cost-effective for patients with fatigue.