Racial Differences and Comparative Clinical Outcomes Among Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease Hospitalized for Covid-19: Insights From the National Inpatient Sample Database
Author Type(s)
Student
Document Type
Abstract
Publication Date
10-2024
DOI
10.1097/HEP.0000000000001077
Journal Title
Hepatology
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in the United States. Literature has shown that patients with advanced chronic liver disease experience higher morbidity and mortality from COVID-19; however, the impact of COVID-19 on those hospitalized with MASLD remains unclear. This study compares the outcomes in MASLD patients with and without COVID-19 using a large nationwide inpatient database.
Methods: National Inpatient Sample (NIS) datasets were used from 2020 to 2021 to identify patients with a diagnosis of MASLD (including MA steatohepatitis, MASH) using ICD-10 codes. Patients under 18 were excluded. Clinical outcomes were compared in hospitalized MASLD patients with or without COVID-19 using multivariable logistic regression, adjusting for confounders.
Results: Of 1,434,504 patients with MASLD, 111,970 patients with MASLD were hospitalized with COVID-19. Outcomes were compared between those without COVID-19 and those with COVID-19. The adjusted odds of mortality were significantly higher in MASLD patients with COVID-19 [aOR: 6.9 (95% CI: 6.53–7.3, p < 0.001)]. Additionally, linear regression analysis showed that the length of stay (LOS) was significantly longer in MASLD patients with COVID-19, with an estimated increase of 4.1 days (95% CI: 3.96–4.25, p < 0.001). Total healthcare charges (THC) were also significantly higher, with an increase of $44,829 (95% CI: $41,571–$48,087, p < 0.001). The odds of requiring endotracheal intubation (EI) were also significantly higher in MASLD patients with COVID-19aOR: 5.12 (95% CI: 4.83–5.43, p < 0.001)]. Furthermore, these patients had increased odds of developing sepsis [aOR: 2.77 (95% CI: 2.59–2.96, p < 0.001)], septic shock [aOR: 2.99 (95% CI: 2.81–3.19, p < 0.001)], bacterial pneumonia [aOR: 1.63 (95% CI: 1.54–1.73, p< 0.001), hepatic encephalopathy (HE) [aOR: 1.31 (95% CI: 1.19–1.44, p < 0.001)], and acute kidney injury (AKI) [aOR: 1.24 (95% CI: 1.19–1.28, p < 0.001)]. (Table 1 & 2).
Conclusion: This study demonstrates that MASLD patients hospitalized with COVID-19 face significantly worse outcomes than those without COVID-19. These patients have higher odds of mortality, LOS, and THC. Additionally, they are at increased risk of requiring EI and developing severe complications such as sepsis, septic shock, bacterial pneumonia, HE, and AKI. Moreover, our study demonstrates significant racial differences, with higher representation of Hispanics, Asian/Pacific Islanders, and Native Americans in the COVID-19 cohort. Given that these findings are based on pre-vaccine data, it is crucial to consider how vaccination may alter these severe outcomes in the post-vaccine era.
Recommended Citation
Vikash, F., Agrawal, S. P., Kumar, V., Vikash, S., Sharma, A., & Rockey, D. (2024). Racial Differences and Comparative Clinical Outcomes Among Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease Hospitalized for Covid-19: Insights From the National Inpatient Sample Database. Hepatology, 80 (Supp. 1), S800-S801. https://doi.org/10.1097/HEP.0000000000001077
