• Karolina M Wronka, Ewa Wunsch, Katarzyna Kozłowska-Petriczko, Maciej Wójcicki, Beata Kruk, and Piotr Milkiewicz.
• Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
• Pol. Arch. Med. Wewn. 2021 Sep 30; 131 (9): 790-796.

IntroductionImpaired elimination of toxic compounds via inadequate sulfation may contribute to the pathogenesis of primary sclerosing cholangitis (PSC). Dehydroepiandrosterone (DHEA), which is metabolized into its sulfated form (DHEA-S) in the liver, has been linked with health-related quality of life (HRQoL) in various conditions.ObjectivesWe aimed to assess the sulfation capacity of the liver in PSC using DHEA-S as a surrogate marker.Patients And MethodsWe assessed serum levels of DHEA-S in 233 patients with PSC and in 201 patients with other liver conditions serving as controls. We also evaluated the effect of low levels of DHEA-S on the course of PSC and HRQoL assessed using the 36-Item Short Form Health Survey (SF-36) and the PBC-40.ResultsThe proportion of patients with low DHEA-S in the PSC group was 7-fold higher than in the control group (21% vs 3%; P <⁠0.001). Patients with decreased levels of DHEA-S were younger at the time of PSC diagnosis (median age, 23 vs 29 years; P = 0.007) and presented with lower HRQoL scores, particularly regarding the physical domains of the SF-36. Patients with low DHEA-S also complained of more severe fatigue (31 vs 23; P = 0.006) assessed with the PBC-40.ConclusionsOur findings support the role of impaired liver sulfation capacity in the development of PSC. Low levels of DHEA-S are associated with increased fatigue, a devastating symptom significantly affecting HRQoL. Thus, the effects of DHEA administration on chronic fatigue and other measures of HRQoL in patients with PSC warrant further attention.

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