{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:06:56Z","timestamp":1789175216645,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Metabolic dysfunction\u2013associated steatotic liver disease (MASLD) is increasingly recognized in patients with primary biliary cholangitis (PBC). While metabolic comorbidities are expected to worsen outcomes, the clinical impact of MASLD in PBC remains uncertain. We investigated whether concomitant MASLD modifies hepatic and cardiovascular outcomes in patients with PBC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective international cohort study using de\u2010identified electronic health records from the TriNetX global research network, including 172 healthcare organizations between 2010 and 2025. Adult patients with PBC with and without MASLD were matched using propensity score matching (1:1) to balance baseline characteristics. The primary outcomes were all\u2010cause mortality. Major adverse cardiovascular events (MACE) and hepatic decompensation were evaluated as secondary outcomes. Additional outcomes included hepatocellular carcinoma, liver transplantation, and one\u2010year biochemical response (ALP normalization).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 30\u2009934 patients with PBC (78.9% female; mean age 68\u2009years), 5955 (19.2%) had concomitant MASLD. After matching, 10\u2009856 patients (5428 per group) were included. Over a mean follow\u2010up of 4\u2009years, patients with PBC\u2010MASLD had a lower risk of all\u2010cause mortality (HR 0.60; 95% CI 0.54\u20130.67) and hepatic decompensation (HR 0.82; 95% CI 0.71\u20130.93), but higher risk of MACE (hazard ratio [HR] 1.30; 95% CI 1.14\u20131.48). One\u2010year biochemical response rates were comparable between groups. Findings remained consistent across multiple sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MASLD identifies a distinct metabolic phenotype of PBC characterized by increased cardiovascular risk but paradoxically lower mortality and hepatic decompensation. These findings highlight the need to integrate cardiovascular risk assessment into the management of patients with PBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70772","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:25:11Z","timestamp":1783401911000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hepatic and Cardiovascular Outcomes in Primary Biliary Cholangitis With Metabolic\u2010Dysfunction Associated Steatotic Liver Disease"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4532-4347","authenticated-orcid":false,"given":"Jarell Jie\u2010Rae","family":"Tan","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2417-7045","authenticated-orcid":false,"given":"Joo Wei Ethan","family":"Quek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology Changi General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean Shao Wei","family":"Lam","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore"},{"name":"Health Services Research Centre Singapore Health Services  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-2631","authenticated-orcid":false,"given":"Ming\u2010Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"},{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Corpechot","sequence":"additional","affiliation":[{"name":"Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis European Reference Network (ERN) on Hepatological Diseases Rare\u2010Liver, INSERM UMR_S938, Saint\u2010Antoine Hospital, Assistance Publique \u2010 H\u00f4pitaux de Paris, Sorbonne University  Paris France"},{"name":"French Network for Rare Liver Disease in Children and Adults FILFOIE Saint\u2010Antoine Hospital, Assistance Publique \u2010 H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2511-7980","authenticated-orcid":false,"given":"Aldo J.","family":"Montano\u2010Loza","sequence":"additional","affiliation":[{"name":"Liver Unit, Division of Gastroenterology, Department of Medicine University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-1183","authenticated-orcid":false,"given":"Yu Jun","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology &amp; 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