EQ-5D outcomes in adults with autoimmune hepatitis: A GRADE-assessed systematic review and meta-analysis

Abstract Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease that can substantially affect health-related quality of life (HRQoL). Although EQ-5D is widely used as a generic preference-based HRQoL instrument, EQ-5D outcomes in adults with AIH have not previously been synthesized in a focused systematic review. This review aimed to summarize EQ-5D outcomes in adults with AIH and assess the certainty of the available evidence using GRADE. A systematic review and meta-analysis was conducted in accordance with PRISMA and prospectively registered in PROSPERO (CRD420261334849). PubMed/MEDLINE, Scopus, Embase, and CENTRAL were searched from inception to 25 February 2026. Studies reporting EQ-5D utility/index, EQ-VAS, and/or domain-level outcomes in adults with AIH were included. Qualitative synthesis served as the primary interpretive framework, and quantitative synthesis was performed as an exploratory summary when appropriate. Certainty of evidence was assessed using GRADE. Five studies were included. Reported EQ-5D utility values ranged from 0.65 to 0.88, and EQ-VAS values ranged from 67.5 to 77.3 across studies. Exploratory random-effects synthesis yielded a pooled EQ-5D utility estimate of 0.80 (95% CI: 0.71 to 0.89; I² = 99.3%) and a pooled EQ-VAS estimate of 70.87 (95% CI: 67.28 to 74.46; I² = 93.9%). However, these pooled values should be interpreted as descriptive summaries of a highly heterogeneous evidence base rather than as stable benchmark estimates. Domain-level data from two studies suggested that pain/discomfort and anxiety/depression were the most frequently affected EQ-5D dimensions. Certainty of evidence was very low for all synthesized outcome groups. Available EQ-5D evidence in adults with AIH suggests an important HRQoL burden, particularly in the pain/discomfort and anxiety/depression domains. However, the evidence base is sparse, highly heterogeneous, and of very low certainty; therefore, pooled EQ-5D and EQ-VAS values should be interpreted as exploratory descriptive summaries rather than definitive benchmark estimates.