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

Background & Aims: 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. Methods: 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. Results: 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. Conclusion: 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.