Concurrent nonalcoholic fatty liver disease may decrease liver fibrosis severity in patients with primary biliary cholangitis

Background The purpose of this study was to evaluate how nonalcoholic fatty liver disease (NAFLD) impacts the progression and prognosis of primary biliary cholangitis (PBC). Methods This retrospective study enrolled patients diagnosed with PBC. NAFLD patients were identified according to the 2023 American Association for the Study of Liver Diseases guidelines. The primary outcome measured the percentage of patients achieving a complete biochemical response as defined by the Paris criteria, while secondary outcomes included non-invasive fibrosis scoring systems and a transplantation-free survival risk model. Statistical analyses employed independent samples Student's t-test or Mann-Whitney U test for continuous variables and Pearson's chi-square or Fisher's exact test for categorical variables, with significance set at a two-tailed P-value of less than 0.05. Results Among 363 patients diagnosed with PBC, 87 (24.0%) were also diagnosed with NAFLD. Biochemical response rates did not differ significantly between patients with only PBC and those with concurrent PBC and NAFLD (P>0.05). However, after one year of ursodesoxycholic acid (UDCA) treatment, significant differences were observed in aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis 4 (FIB-4) score between PBC patients with and without NAFLD (APRI: 0.35 vs. 0.47, P = 0.02; FIB-4 score: 1.95 vs. 2.53, P = 0.01). The GLOBE score revealed that patients with both PBC and NAFLD had higher 5-, 10-, and 15-year liver transplant-free survival rates compared to those with only PBC (81.9%, 58.3%, and 38.0% respectively, all P < 0.05). Conclusions Patients with concurrent PBC and NAFLD do not significantly impact the biochemical response to UDCA but may improve the degree of liver fibrosis and long-term prognosis.