The overlap with metabolic dysfunction-associated steatotic liver disease negatively affects outcomes of primary biliary cholangitis

Abstract

Background and Aims: The relationship between primary biliary cholangitis (PBC)and metabolic dysfunction-associated steatotic liver disease, and its impact on treat-ment response and prognosis, remains underexplored.Methods: Patient cohort from two centres comprising long-term follow-up data.All patients had histologically confirmed PBC. Biopsies were classified according toNon-Alcoholic Steatohepatitis Clinical Research Network. Diagnosis of metabolicdysfunction-associated steatotic liver disease was established when steatosis ex-ceeded 5%, along with at least one metabolic risk factor. Patients with specific aetiol-ogies of steatosis, other liver diseases, incomplete results and inadequate treatmentwith ursodeoxycholic acid were excluded. Data from patients initiating second-linetreatment were censored. Treatment response was assessed using the Toronto, ParisII and AST-to-platelet at 12-month criteria. The UK PBC and Globe scores, and liverevents were utilized as outcome measures.Results: The study included 129 patients, 36 showing histologically confirmed over-lap between PBC and steatosis. Patients with overlap showed worse prognosis ac-cording to Paris II (61.1% vs. 33.3%, p = 0.004), Toronto (52.5% vs. 24.7%, p = 0.002),AST-to-platelet 12-month >0.54 (36.1% vs. 17.2%, p = 0.021), Globe >0.30 (49.2% vs.29.2%, p = 0.033) and UK PBC at 5, 10 and 15 years (p ≤ 0.001). Liver-related mortalityand liver transplant were more prevalent in the overlap group (p = 0.001). In the mul-tivariate analysis, steatosis, dyslipidaemia and advanced fibrosis were independentlyassociated to worse outcomes.Conclusions: Our findings suggest that metabolic dysfunction-associated steatoticliver disease worsens the prognosis of PBC