Primary biliary cholangitis has the worst quality of life indicators among the autoimmune liver diseases: A United States cohort.

Introduction And Objectives: Autoimmune liver diseases (AILDs) affect health-related quality of life (HRQOL). This seven-year, prospective study analyzes the impact of AILDs on HRQOL.

Materials And Methods: We collected the Chronic Liver Disease Questionnaire (CLDQ) and the EuroQol-5 Dimension (EQ-5D), totaling 1214 responses from 466 AILD patients (2017-2024). CLDQ was compared via Kruskal-Wallis. Chi-square and ANOVA were used for EQ-5D frequencies and means. Multivariate (MVA) regressions identified CLDQ symptom predictors. Tobit regression analyzed EQ-5D UI. Pearson's correlation assessed CLDQ-EQ-5D association.

Results: We included 230 AIH, 118 PSC, and 118 PBC patients. Total CLDQ was lower in PBC compared to AIH and PSC (5.25, 5.54, 5.59; P < 0.001), as was EQ-5D UI (0.85, 0.88, 0.88; P < 0.001). In CLDQ, PBC domains were significantly worse except Worry. Fatigue scored lowest in PBC, with tiredness, decreased energy, and daytime sleepiness as the most debilitating symptoms (3.91, 4.20, 4.27; P < 0.001). In EQ-5D, every item was worse in PBC except anxiety/depression, with pain being worst (P < 0.001). CLDQ MVA identified female (β: -0.26), Hispanic race (β: -0.31), and MASLD/MASH (β: -0.32) as predictors of symptom worsening (P < 0.05). Tobit regression for EQ-5D revealed female (β: -0.03), MASLD/MASH (β: -0.07), and cirrhosis (β: -0.06) as symptom severity predictors (P < 0.05). Pearson's correlation showed that CLDQ and EQ-5D in AILD were strongly correlated (r = 0.63; P < 0.001).

Conclusions: Among AILDs, PBC most severely impacts HRQOL, especially in tiredness, sleepiness, concentration, and pain. Female, Hispanic, and MASLD overlap patients are disproportionately affected. Both CLDQ and EQ-5D predict symptom severity, but CLDQ identifies more predictors and stronger associations.