S2509 Prevalence and Impact of Steatotic Liver Disease in Patients With Autoimmune Liver Diseases: A Systematic Review and Meta-Analysis

Introduction: Steatotic liver disease (SLD) is a growing global health concern, affecting approximately 30% of adults worldwide. SLD frequently co-occur with chronic liver diseases, including autoimmune liver diseases (AILDs) such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). However, data on this overlap are limited and have not been systematically assessed. This systematic review and meta-analysis aimed to examine the epidemiology, clinical features, and long-term outcomes of SLD in patients with AILDs. Methods: PubMed and Embase were searched from inception to May 20, 2025, for observational studies describing the prevalence and impact of hepatic steatosis in AILDs. A meta-analysis of proportions was performed using a generalized linear mixed model with Clopper-Pearson intervals. A pairwise meta-analysis using a random-effects model was conducted to obtain pooled odds ratios (ORs) or standardized mean differences (PROSPERO ID: CRD420251057378). Results: Forty-5 studies were included: 5,344 AIH patients (22 studies), 3,485 PBC patients (21 studies), and 987 PSC patients (8 studies). SLD prevalence was highest in AIH (31.97%, 95% CI 22.70–42.94), followed by PBC (26.03%, 95% CI 17.59–36.72) and PSC (17.05%, 95% CI 10.75–25.97), with high heterogeneity (I² > 90%). Patients with both AILD and SLD had higher body mass index and were more likely to have diabetes, hypertension, and dyslipidemia. SLD was associated with differences in liver enzymes in AIH and PBC. In AIH, SLD was associated to a higher risk of significant fibrosis (OR 1.34, 95% CI 1.004–1.79, P = 0.047) and advanced fibrosis (OR 1.84, 95% CI 1.37–2.47, P < 0.001), but not in PBC or PSC. SLD was also associated with increased mortality in AIH (OR 1.83, 95% CI 1.15–2.93, P = 0.01), with no impact in PBC; its effect in PSC remains unclear. Conclusion: SLD commonly coexists with AILDs, though its impact varies by disease type. In AIH, SLD is linked to more severe histology and worse prognosis, supporting routine screening and targeted management. In PBC, the impact appears limited to clinical features. Data for PSC remain inconclusive and warrant further study.