Objective: To investigate the predictive efficiency of pre-treatment neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and related antibody levels on the disease outcomes of patients with primary biliary cholangitis (PBC) receiving ursodeoxycholic acid (UDCA) treatment. Methods: A total of 120 PBC patients undergoing UDCA were included. All patients were treated with 13–15 mg·kg?1·d?1 of UDCA for 12 months. According to the biochemical response criteria at 12 months, the patients were classified into a good response group (n = 82) and a poor response group (n = 38). NLR, MPV, and positive antibody conditions [anti-mitochondrial antibody (AMA), anti-gp210 antibody, anti-sp100 antibody] were collected and compared between both groups before treatment. Multivariate Logistic regression analysis was utilized to screen independent predictors for disease outcomes, and the predictive efficiency was assessed by receiver operating characteristic (ROC) curve. Results: Among the 120 patients, the UDCA response rate was 68.33% (82/120). Pre-treatment NLR and MPV levels in the poor response group were higher than those in the good response group (P < 0.05), and the positive rates of anti-gp210 and anti-sp100 antibodies were higher (P < 0.05). No statistically significant difference in the AMA positive rate was found between the two groups (P > 0.05). Multivariate regression analysis indicated that elevated NLR and MPV, as well as positive anti-gp210 antibody, were independent risk factors for poor UDCA response (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of combined prediction of disease outcomes in PBC patients treated with UDCA by NLR, MPV, and anti-gp210 antibody was 0.941, with a sensitivity of 92.11% and a specificity of 86.59%. Conclusion: Pre-treatment levels of NLR, MPV, and anti-gp210 antibody have good predictive value on poor 12-month biochemical response to UDCA treatment in PBC patients. Combined detection can enhance the predictive efficiency, aiding in the early identification of high-risk patients and guiding individualized treatment.