Risk factors for poor response to autoimmune hepatitis: A systematic review and meta-analysis

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease and its prognosis is closely related to treatment response. This meta-analysis aimed to identify baseline predictors of treatment response in AIH.

PubMed, Embase, Ovid MEDLINE, and the Cochrane Library were searched from inception to August 24, 2025. Study quality was assessed independently by two reviewers using the Newcastle-Ottawa Scale. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were pooled using random-effects models. Subgroup analyses, sensitivity analysis and evidence certainty assessment were also performed.

Forty-eight studies were included. Favorable treatment response was associated with older age (SMD: 0.41, 95% CI: 0.23-0.58), lower immunoglobulin G (IgG) levels (SMD: -0.71, 95% CI: -1.04 to -0.37), higher platelet count (SMD: 0.28, 95% CI: 0.03-0.54), mild fibrosis (OR: 0.15, 95% CI: 0.07-0.35), and rosette formation (OR: 0.21, 95% CI: 0.07-0.67). Poor treatment response was associated with smooth muscle antibodies (SMA) (OR: 1.42, 95% CI: 1.10-1.84) and baseline cirrhosis (OR: 2.61, 95% CI: 1.69-4.02).

Age, platelet count, IgG level, SMA, mild liver fibrosis, rosettes, and cirrhosis were associated with treatment response in AIH and may help inform risk stratification. REGISTRY AND THE REGISTRATION NO.

PROSPERO registration number CRD42024623543.