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However, it remains unknown whether UDCA prevents long COVID outcomes in patients with steatotic liver disease (SLD)\u2014a population vulnerable to adverse outcomes. We investigated the association between pre-infection UDCA use and risk of long COVID outcomes in patients with SLD.Methods: We conducted a nationwide retrospective cohort study using the Korean COVID-19 registry linked to National Health Insurance Service claims data (2019\u20132022). Patients with SLD (fatty liver index \u226530) who experienced COVID-19 were included. Exposure was defined as at least one UDCA prescription within the 90 days preceding infection. Outcomes of interest were 20 incident long COVID conditions across eight organ systems assessed \u226584 days post-infection. After propensity score (PS) fine stratification, hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox regression.Results: Among 469,108 patients with SLD and COVID-19, 23,560 (5.0%) were UDCA users. After PS fine stratification weighting, UDCA use was not associated with reduced risk for most long COVID outcomes. A protective association was observed for atrial fibrillation (HR 0.51, 95% CI 0.30\u20130.88), whereas increased risks were found for type 2 diabetes mellitus (HR 1.24, 95% CI 1.09\u20131.42) and epilepsy (HR 1.69, 95% CI 1.09\u20132.61).Conclusions: Pre-infection UDCA use was not associated with reduced risk for most long COVID outcomes in patients with SLD. The observed associations warrant cautious interpretation given potential residual confounding and surveillance bias.<\/jats:p>","DOI":"10.3350\/cmh.2026.0283","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:30:07Z","timestamp":1781047807000},"page":"1364-1378","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ursodeoxycholic acid and long COVID in steatotic liver disease: a nationwide cohort study"],"prefix":"10.3350","volume":"32","author":[{"given":"Kyungyeon","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gi-Ae","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieun","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Youn","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Young","family":"Choi","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"},{"name":"Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungho","family":"Bea","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahhyung","family":"Choi","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heejoon","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae Kyung","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1010-7525","authenticated-orcid":true,"given":"Ju-Young","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, 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