SAT-695 - Inpatient Outcomes Associated with MASLD/NASH in Adults with Type 1 Diabetes and Obesity: A Nationwide Inpatient Sample Study

Background
Metabolic dysfunction–associated steatotic liver disease (MASLD), including nonalcoholic steatohepatitis (NASH), is increasingly recognized among individuals with diabetes and obesity. However, contemporary nationwide data describing its association with inpatient outcomes among adults with Type 1 diabetes (T1D) and obesity are limited.

Methods
Using the 2022 Nationwide Inpatient Sample (NIS), representing hospitalizations from calendar year 2022, we performed a retrospective cross-sectional analysis of adult hospitalizations with coexisting T1D and obesity. MASLD/NASH was identified using ICD-10-CM codes. National estimates were generated using discharge weights to account for the NIS survey design. Survey-weighted regression models adjusted for age, sex, and key comorbidities were used to evaluate associations with in-hospital mortality, acute liver failure and length of stay (LOS).

Results
Among 6,657 unweighted hospitalizations (population-weighted estimate 33,285 discharges), outcomes were compared between admissions with and without MASLD/NASH. After multivariable adjustment, MASLD/NASH was not independently associated with in-hospital mortality (adjusted OR 0.55, 95% CI 0.13–2.24; p=0.40). In contrast, patient-level factors were important determinants of mortality: increasing age was associated with higher odds of death (OR 1.04 per year, 95% CI 1.03–1.06; p< 0.001), while female sex was associated with lower mortality risk (OR 0.59, 95% CI 0.39–0.90; p=0.013). Among comorbidities, complicated hypertension was strongly associated with increased mortality (OR 2.11, 95% CI 1.33–3.33; p=0.001), whereas complicated diabetes and dementia were not significantly associated.
In contrast to mortality outcomes, MASLD/NASH was associated with a higher risk of acute liver failure compared with admissions without MASLD/NASH (adjusted OR 2.37, 95% CI 1.00–5.62; p=0.05). Older age was also associated with increased odds of acute liver failure (OR 1.02 per year, 95% CI 1.01–1.03; p=0.006), while sex was not a significant predictor.
With respect to healthcare utilization, MASLD/NASH was not associated with hospital LOS in adjusted linear regression models (β 0.16 days, 95% CI −0.56 to 0.88; p=0.66). Increasing age was associated with longer hospitalizations, whereas sex was not significantly associated with LOS.

Conclusions
In a contemporary nationwide cohort of adults with T1D and obesity, MASLD/NASH was not independently associated with in-hospital mortality or LOS but was associated with increased odds of acute liver failure. These findings suggest that inpatient risk in this population may be driven more by age and cardiovascular comorbidities, particularly complicated hypertension, than by hepatic steatosis alone. This highlights the need for targeted risk stratification rather than uniform escalation of inpatient care.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*