Abstract
<title>Abstract</title> <p>Background The prevalence of pruritus and its impact on health-related quality of life (HRQoL) remain under-characterized in Chinese patients with primary biliary cholangitis (PBC) in real-world settings, particularly regarding the dissociation between biochemical response and symptom persistence. Aim To evaluate the prevalence, risk factor, and psychological impact of pruritus in Chinese patients with PBC. Methods We conducted a cross-sectional study of 415 PBC patients. Pruritus intensity (Numeric Rating Scale), fatigue (FACIT-F), HRQoL (EQ-5D-3L), and anxiety/depression (HADS) were assessed. Multivariate regression identified independent associations, with subgroup analyses exploring heterogeneity in the impact of anxiety/depression. Results This study included 415 PBC patients. The overall prevalence of pruritus was 39.5% (164/415), with 11.1% of patients reporting moderate-to-severe symptoms. Patients experiencing pruritus exhibited higher rates of cirrhosis (56.7% vs. 37.5%, P < 0.001), lower UDCA response rates (52.4% vs. 70.9%, P < 0.001). Independent predictors of pruritus included longer disease duration (OR = 1.053), lower albumin (OR = 0.918), and a higher ALP/ULN ratio (OR = 1.304). Pruritus intensity correlated with fatigue, anxiety, and depression (P < 0.001 for all). Notably, subgroup analysis revealed that the association between pruritus and depression was most pronounced in non-cirrhotic patients (aOR = 2.54) and those achieving biochemical response (aOR = 3.28). Conclusion Nearly 40% of treated PBC patients suffer from persistent pruritus, potentiating fatigue, psychological distress, and HRQoL impairment. Paradoxically, this burden is more severe in early-stage disease or biochemical response, suggesting clinical management to include routine symptom assessment and psychological support.</p>