Early Prognostic Factors for Reduced Survival in Autoimmune Hepatitis: A Systematic Review With Meta-Analysis

Autoimmune hepatitis (AIH) is a severe, life-threatening condition for some patients. This systematic review aimed to identify and rank early prognostic factors associated with reduced survival in AIH.

A systematic search was conducted in Ovid Medline and embase.com up to April 2024 for identifying early prognostic factors for the combined endpoints of death or liver transplantation and liver-related death or liver transplantation. Overview tables of prognostic factors were constructed to outline the number of studies, the respective effect direction, and the statistical significance. Meta-analysis was performed if at least 3 studies reported on a factor. The level of certainty in evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline.

Thirty-three studies were included, and 44 prognostic factors were investigated in at least 2 studies. Cirrhosis at diagnosis (hazard ratio [HR], 3.21; 95% confidence interval [CI], 2.38-4.34) and insufficient response to therapy (HR, 4.35; 95% CI, 2.5-7.58) were significant predictors with the highest risk ratios. Additional factors associated with reduced survival include advanced age, non-Caucasian ethnicity, variant syndrome with primary sclerosing cholangitis, asymptomatic presentation, higher relapse rates and elevated international normalized ratio, creatinine, alkaline phosphatase/aspartate aminotransferase ratio, and Model for End-stage Liver Disease score. Protective factors include elevated baseline levels of aminotransferases and albumin levels.

Cirrhosis and insufficient treatment response are the prognostic factors with the highest impact on reduced survival in AIH. Other risk factors include advanced age, non-Caucasian ethnicity, primary sclerosing cholangitis-variant syndrome, asymptomatic presentation, higher relapse rates and elevated international normalized ratio, creatinine, alkaline phosphatase/aspartate aminotransferase ratio, and Model for End-stage Liver Disease score, whereas elevated baseline aminotransferases and albumin are protective.