Effect of ursodeoxycholic acid on changes in non-invasive calculated indices of steatosis and fibrosis in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

Introduction. Ursodeoxycholic acid (UDCA) significantly reduces markers of cytolysis and cholestasis in patients with nonalcoholic fatty liver disease (NAFLD); however, its role in improving non-invasive markers of steatosis and fibrosis remains a matter of discussion. Aim . To evaluate the effect of UDCA therapy on changes in non-invasive calculated indices of steatosis and fibrosis in patients with NAFLD. Materials and methods . This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. The study protocol was prospectively registered in the international PROSPERO database (CRD420261396761). MEDLINE/PubMed, Embase, the Cochrane Library, Scopus, and the Russian Science Citation Index were searched through February 3, 2026. Studies evaluating changes in non-invasive markers of steatosis (FLI and St-index) or fibrosis (FIB-4, NFS, APRI, and FibroTest) in adult patients with NAFLD receiving UDCA therapy were included. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the quantitative synthesis. Results . Eight studies involving a total of 729 patients were included in the meta-analysis. UDCA therapy was associated with statistically significant reductions in FLI (SMD = −0.58; 95% CI: −0.75 to −0.41; n = 7), FIB-4 (SMD = −0.63; 95% CI: −1.15 to −0.11; n = 4), APRI (SMD = −0.49; 95% CI: −0.93 to −0.05; n = 3), and FibroTest (SMD = −0.07; 95% CI: −0.13 to −0.01; n = 1). A trend towards improvement was observed for NFS, although the result did not reach statistical significance (SMD = −0.62; 95% CI: −1.32 to 0.08; n = 4). An additional pooled analysis of the full study set, with avoidance of double-counting, demonstrated a statistically significant reduction in non-invasive fibrosis indices after UDCA therapy (SMD = −0.16; 95% CI: −0.21 to −0.11; n = 7). Conclusion. UDCA therapy in patients with NAFLD is associated with statistically significant reductions in non-invasive calculated indices of steatosis (FLI) and fibrosis (FIB-4 and APRI).