Adipokine profiles reflect metabolic dysfunction but not fibrosis in patients with primary biliary cholangitis

Abstract

BACKGROUND

Primary biliary cholangitis (PBC) is a rare, nonsuppurative cholestatic disease that affects the small intrahepatic bile ducts. If not adequately managed, it may progress to liver cirrhosis and hepatocellular carcinoma. Only a few studies have explored the impact of cardiometabolic risk factors on liver fibrosis progression in PBC. Relevant data on the role of adipokines in these processes are also limited.

AIM

To compare leptin and adiponectin levels in PBC patients stratified by the presence of metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic syndrome (MetS), fibrosis, and biochemical response.

METHODS

We conducted a cross-sectional study involving 81 PBC patients diagnosed according to European Association for the Study of the Liver guidelines, all followed at a tertiary care center in Košice, Slovakia. Patients were included consecutively from the patient database in hepatology clinic in a prospective manner. Data on biochemical, clinical and anthropometric variables and their associations with MASLD, MetS, fibrosis, and biochemical response were evaluated using statistical methods including logistic regression and receiver operating characteristic analysis.

RESULTS

Patients with PBC/MASLD had significantly lower adiponectin levels (1698.24 pg/mL vs 2042.08 pg/mL, P = 0.015) and higher leptin levels (1.89 ng/mL vs 0.62 ng/mL, P < 0.001) compared with those without MASLD. The leptin-to-adiponectin (L/A) ratio was also significantly elevated (1.63 vs 0.27, P < 0.001). Similar patterns were observed in patients with MetS: Adiponectin (1208.41 pg/mL vs 2086.10 pg/mL, P = 0.002), leptin (1.51 ng/mL vs 0.79 ng/mL, P = 0.002), and L/A ratio (1.28 vs 0.41, P = 0.009). By contrast, no significant differences in adipokine levels were observed between patients with and without advanced fibrosis or complete biochemical response (all P > 0.05).

CONCLUSION

Adipokines reflect metabolic status in PBC. The L/A ratio is promising biomarker for MASLD. No significant association between leptin and adiponectin levels and advanced fibrosis was detected within the limited sample size of this study.

Keywords: Primary biliary cholangitis; Adipokines; Liver fibrosis; Metabolic dysfunction-associated steatotic liver disease; Metabolic syndrome

Core Tip: Our results show that primary biliary cholangitis (PBC) patients with metabolic dysfunction-associated steatotic liver disease or metabolic syndrome as comorbidities exhibit significantly lower adiponectin levels, higher leptin levels, and an elevated leptin-to-adiponectin ratio within the limited sample size of this study. Thus, adipokines may serve as potential biomarkers for identifying metabolic conditions in PBC. By contrast, no significant associations were observed between adipokine levels and fibrosis severity or biochemical response. Our findings indicate that adipokines, particularly leptin-to-adiponectin ratio may become a promising biomarker for identifying metabolic dysfunction-associated steatotic liver disease in PBC patients.