Steatotic liver disease in autoimmune liver disease: Prevalence and clinical impact in a Southeast Asian cohort

Background: Steatotic liver disease (SLD) is increasingly common in patients with primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH). We sought to determine the prevalence and clinical impact of SLD among Southeast Asian patients with PBC, AIH, and AIH/PBC overlap syndrome. Methods: We included all patients diagnosed with PBC, AIH and AIH/PBC overlap syndrome between 2000 and 2024. SLD was defined based on either radiological or histological evidence of hepatic steatosis. The primary outcomes were all-cause mortality, treatment response, liver-related events (LRE), and major adverse cardiovascular events (MACE). Results: Among 273 patients (PBC: 184, AIH: 69, AIH/PBC overlap syndrome: 20), one third had concomitant SLD. Patients with PBC/SLD were more likely to have a higher BMI (24.6 versus 22.6 kg/m 2 , p = 0.002) and less likely to have liver cirrhosis (36.7% versus 59.3%, p = 0.011) than PBC without SLD. AIH patients had a significantly higher risk of developing de novo SLD. Patients with PBC/SLD have a significantly lower risk of all-cause mortality (unadjusted HR 0.33, adjusted HR 0.18, p < 0.05 for both). Concomitant SLD did not influence the treatment response, occurrence of LRE, or MACE in patients with PBC, AIH, or AIH/PBC overlap syndrome. Conclusions: Concomitant SLD does not influence treatment response, liver-related events, or cardiovascular outcomes in patients with autoimmune liver disease.