PREVALENCE AND PREDICTORS OF METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE IN A RETROSPECTIVE COHORT OF PATIENTS WITH ULCERATIVE COLITIS

Abstract BACKGROUND Metabolic dysfunction associated steatotic liver disease (MASLD) is observed in both ulcerative colitis (UC) and Crohn's disease, affecting around 27.5% of cases over an average duration of 4.6 years. However, data on the prevalence, associated predictors, and outcomes of MASLD in UC patients remains scarce. METHODS We conducted a nationwide retrospective cohort study to assess the prevalence, associated comorbidities, risk determinants, gastrointestinal complications, and hospitalization outcomes related to MASLD in UC patients. Descriptive statistics were used to summarize patient demographics and manifestations. Univariate and multivariate logistic regression models were used to evaluate the predictors and consequences of MASLD among patients with UC. RESULTS 204,966 hospital discharges diagnosed with UC were extracted, 1.8% (3,733) of the patients had MASLD (Figure 1). Compared to UC patients without MASLD, those with MASLD had a significantly prolonged median length of stay (LOS) (6 days; IQR: 3-9 vs. 4 days; IQR: 2-6, P<0.002) and higher median total charges ($69,547 vs. $65,738, P<0.05) (Table 1). Patients with Metabolic dysfunction-associated steatohepatitis (MASH) had notably increased mortality rates (4.8% vs. 2.1%, P=0.004), longer median LOS (8 vs. 6 days, P<0.001), and greater median total charges ($81,152 vs. $65,752, P<0.001) than those without MASH. UC patients with MASLD had a higher prevalence of conditions such as diabetes mellitus (28.1% vs. 19.6%, P<0.001), obesity (26.8% vs. 11.2%, P<0.001), metabolic syndrome (0.7% vs. 0.1%, P<0.001), dyslipidemia (33.2% vs. 28.6%, P<0.001), and vitamin D deficiency (4.1% vs. 2.7%, P<0.001). They also had a higher prevalence of ulcerative pancolitis (22.9% vs. 15.3%, P<0.001) and left-sided colitis (6.8% vs. 4.1%, P<0.001). Conditions such as metabolic syndrome (OR: 3.36; 95% CI: 2.25 – 5.50, P<0.001), abnormal liver function tests (OR: 3.00; 95% CI: 2.01 - 4.48, P<0.001), obesity (OR: 2.51; 95% CI: 2.33 - 2.72, P<0.001), diabetes mellitus (OR: 1.32; 95% CI: 1.22 - 1.43, P<0.001), vitamin D deficiency (OR: 1.40; 95% CI: 1.18 - 1.64, P<0.001), ulcerative pancolitis (OR: 1.64; 95% CI: 1.51 - 1.78, P<0.001), dyslipidemia (OR: 1.27; 95% CI: 1.18 - 1.38, P<0.01), gallstone disease (OR: 3.75; 95% CI: 3.16 - 4.45, P<0.001), chronic pancreatitis (OR: 3.20; 95% CI: 2.65 - 3.88, P<0.001), thrombocytopenia (OR: 1.60; 95% CI: 1.41 - 2.81, P<0.001), and the age group 45-64 (OR: 1.31; 95% CI: 1.20-1.42, P<0.001) were significant positive predictors for MASLD in UC patients. CONCLUSIONS MASLD is a common comorbidity in UC patients and significantly influences both morbidity and mortality. We identified multiple positive predictors of MASLD in patients with UC, and further studies are needed to study early detection and improve long-term outcomes among UC patients.