Early prognostic factors for reduced survival in autoimmune hepatitis: a systematic review with meta-analysis

Abstract

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 statistical significance. Meta-analysis was performed if at least three studies reported on a factor. The level of certainty in evidence was evaluated using the GRADE guideline.

Results: Thirty-three studies were included, and 44 prognostic factors were investigated in at least two studies. Cirrhosis at diagnosis (HR 3.21, 95% 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 PSC, asymptomatic presentation, higher relapse rates and elevated INR, creatinine, ALP/AST ratio, and MELD 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, PSC-variant syndrome, asymptomatic presentation, higher relapse rates and elevated INR, creatinine, ALP/AST ratio, and MELD score, while elevated baseline aminotransferases and albumin are protective.

Keywords: Autoimmune hepatitis; Cirrhosis; Insufficient response; Prognosis.