SUN-715 - Metabolic Steatohepatitis (MASH) Does Not Drive 30-Day Readmission in Hospitalized Patients with Diabetes: A Nationwide Analysis

Title:
Metabolic Steatohepatitis (MASH) does Not Drive 30-Day Readmission in Hospitalized Patients With Diabetes: A Nationwide Analysis

Background:
Metabolic dysfunction–associated steatohepatitis (MASH) frequently coexists with diabetes mellitus (DM) and is associated with advanced cardiometabolic and hepatic comorbidity. However, its impact on short-term hospital outcomes, particularly 30-day readmission and mortality, in a national diabetic cohort remains poorly defined.

Methods:
We analyzed adult hospitalizations with diabetes in the Nationwide Readmissions Database in 2022. Patients were stratified by presence of MASH. Survey-weighted estimates were used to compare 30-day readmission rates, causes of readmission, baseline characteristics, in-hospital complications, and mortality. Multivariable survey-weighted Cox proportional hazards models evaluated the independent association of MASH with 30-day readmission and in-hospital mortality, adjusting for demographics, socioeconomic status, hospital characteristics, and comorbid conditions.

Results:
Among 5.52 million weighted diabetic index admissions, 207,105 (3.8%) had MASH. Thirty-day readmission rates were identical in patients with and without MASH (16.1% vs 16.0%, p=0.71). In adjusted analysis, MASH was not independently associated with 30-day readmission (HR 1.00, 95% CI 0.98–1.01). Readmission risk was driven by heart failure, acute kidney injury, chronic kidney disease, end-stage renal disease, sepsis, ICU admission, cirrhosis, and acute hepatic failure. The most common causes of readmission were sepsis, heart failure, acute kidney injury, pneumonia, COVID-19, and diabetic ketoacidosis; liver-related diagnoses ranked prominently only among the MASH subgroup. Despite higher prevalence of cirrhosis and hepatic failure, MASH was independently associated with lower 30-day in-hospital mortality compared with non-MASH diabetes (HR 0.89, 95% CI 0.87–0.92), while mortality was strongly predicted by critical illness (ICU admission, mechanical ventilation), sepsis, acute kidney injury, myocardial infarction, and advanced liver disease.

Conclusions:
In a national cohort of hospitalized patients with diabetes, MASH does not independently increase 30-day readmission risk. Short-term outcomes are driven primarily by cardiorenal failure, sepsis, and advanced cirrhosis rather than by the presence of steatohepatitis itself. These findings suggest that readmission reduction strategies in diabetic patients should prioritize management of acute organ dysfunction and decompensated cirrhosis rather than MASH alone.

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