Pilot Validation of an AI-based Audiovisual Fatigue Assessment Tool (mAI Fatigue) in Chronic Liver Disease: A Multicentre Study

Fatigue affects over half of patients with chronic liver disease (CLD) and is a major driver of impaired quality of life, yet it remains underrecognised because assessment relies almost entirely on subjective patient-reported outcomes (PROs). This proof of concept study evaluated whether audiovisual (AV) markers from facial and vocal expressions, captured via the mAI Fatigue tool (Blueskeye), could serve as objective correlates of fatigue in CLD. In a prospective, multicentre, case-control study at three sites in India, 111 adults (aged 18 to 65 years) were enrolled as healthy controls (n=55) or CLD patients with moderate to severe fatigue (n=56). Over four weeks, participants completed ten assessments combining validated PROs, Psychomotor Vigilance Task (PVT) reaction times and AV recordings. CLD participants had significantly slower PVT reaction times than controls (882 vs 776 ms; p=0.0047). Session-level AV-PRO correlations were modest (r=-0.17 to -0.27), but participant-level aggregation strengthened associations (r=-0.47; p{approx}0.002) in the high-quality audio subset (n=41), where a predictive model achieved R=0.75 to 0.76 (p<0.001); associations were strongest in older participants, women, those with severe fatigue and MASLD aetiology. AI-derived AV markers, particularly when anchored to an individual baseline and aggregated longitudinally, show promise as objective, complementary measures of fatigue in CLD and warrant validation in larger, diverse cohorts.