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. 2025 Jun;49(6):102598.
doi: 10.1016/j.clinre.2025.102598. Epub 2025 Apr 26.

Clinical outcomes in patients with autoimmune hepatitis and primary biliary cholangitis overlap syndrome in the United States

Ritik M Goyal  1 , Bhavik Bansal  2 , Mohammed Ayyad  3 , Aagamjit Singh  4 , Esli Medina Morales  3 , Imran Qureshi  3 , Muhammad Hassaan Arif Maan  3 , Paul J Gaglio  5
Affiliations
Free article

Clinical outcomes in patients with autoimmune hepatitis and primary biliary cholangitis overlap syndrome in the United States

Ritik M Goyal et al. Clin Res Hepatol Gastroenterol. 2025 Jun.
Free article

Abstract

Background: There is evidence of overlap between autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), two autoimmune hepatobiliary diseases. This retrospective analysis aimed to investigate extra-hepatic auto-immune diseases and compare outcomes of hospitalized patients with AIH-PBC overlap with AIH and PBC. We hypothesize that there are differences in rates of major adverse liver outcomes (MALO's) when comparing these groups.

Methods: We conducted a retrospective cohort study using National Inpatient Sample 2016-2020. Patients with AIH, PBC and AIH-PBC were identified using respective ICD-10 codes. We performed weighted logistic and linear regression for predicting complications of cirrhosis, hospitalization outcomes, among AIH-PBC overlap cases when compared separately to AIH and PBC only populations as controls.

Results: A total of 2454 AIH, 1464 PBC, and 276 AIH-PBC overlap patients were identified, corresponding to weighted totals of 12,270, 7320 and 1380 patients, respectively. On multivariate analysis, we found that patients with AIH-PBC are more likely to have ascites (OR 3.03; p < 0.001) and portal hypertension (OR 3.75; p < 0.001) compared to AIH; whereas no significant difference was found out compared to PBC. There was no difference in the mortality and liver transplant needs in AIH-PBC overlap group. Overall higher rheumatological disease was present in the AIH-PBC overlap patients compared to AIH (26.45 % vs 8.96 %, p =< 0.001) and PBC (26.45 % vs 9.08 %, p =< 0.001). Specifically, AIH-PBC patients had higher prevalence of Sjogren's syndrome (p < 0.001), SLE (p < 0.001), and systemic sclerosis (p < 0.001).

Conclusion: AIH-PBC Overlap syndrome is associated with increased rates of certain cirrhotic complications when compared to patients with AIH only. They do not differ in terms of clinical outcomes such as mortality when adjusted for demographics and comorbidities. Patients with AIH-PBC had a higher prevalence of rheumatological disorders; especially Sjogren's, SLE, and systemic sclerosis.

Keywords: AIH-PBC overlap syndrome; Autoimmune hepatitis; Major adverse liver outcomes; National inpatient sample; Primary biliary cholangitis.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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