Abstract: Objective The aim of this study was to investigate the clinical feature and risk factors impacting response to immunosuppressive therapy in elderly patients with autoimmune hepatitis (AIH). Methods 61 elderly patients with AIH were encountered in our hospital between January 2023 and June 2025, and all received immunosuppressive therapy for six months. Patients underwent liver biopsies and serum IgG and IgM levels were detected. Frailty score was assessed and sarcopenia was diagnosed. Multivariate Logistic regression analysis was performed to identify independent factors impacting response to immunosuppressive therapy. Results By end of six-month treatment, complete response (CR) was obtained in 47 cases, and non-CR (NCR) was found in 14 cases; baseline body mass index in patients with NCR was much lower(P<0.05), while percentages of concomitant diabetes, hypertension and sarcopenia, and frailty score were much higher than in those with CR(P<0.05); baseline serum ALT, AST, IgG and IgM levels were 158.2(92.3, 243.4)U/L, 132.1(85.3, 221.5)U/L, (23.6±4.8)g/L and (2.1(1.6, 2.5)g/L, all much higher than [106.3(71.8, 159.1)U/L, 95.6(64.1, 147.2)U/L, (19.7±3.9)g/L and 1.7(1.2, 2.1)g/L, respectively, P<0.05] in patients with CR; lobular inflammation, bile duct injury, steatosis, interface inflammation and fibrosis were more severe in patients with NCR than in those with CR(all P<0.05); multivariate Logistic regression analysis indicated that frailty score, sarcopenia, diabetes, elevated IgG level, hepatic bile duct injury and fibrosis were all the independent risk factors for poor response to immunosuppressive therapy(P<0.05), while serum albumin level was a protective factor (P<0.05). Conclusion Elderly patients with AIH might not response to immunosuppressive therapy, and the criminal factors should be taken into consideration in dealing with them.

Key words: Autoimmune hepatitis, Immunosuppressive therapy, Response, Risk factors, Therapy