The Rising Inpatient Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease: Insights From the Nationwide...

Background and objective Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common and is a growing public health concern. However, data on MASLD prevalence and outcomes among hospitalized adults in the United States are limited. Therefore, this study sought to evaluate the inpatient burden of MASLD, along with associated outcomes and patterns of resource utilization. Methods We analyzed 2018-2022 Nationwide Inpatient Sample (NIS) data for adult MASLD hospitalizations using the International Classification of Diseases, 10th Revision (ICD-10) codes and excluded secondary liver diseases. Survey-weighted multivariable models assessed the prevalence of the condition and the association between MASLD and inpatient mortality, adjusting for demographic, clinical, and hospital-level confounders. Sensitivity models included cirrhosis and hepatocellular carcinoma (HCC). Results Among 144 million adult hospitalizations, the prevalence of MASLD rose from 1.77% to 3.90% during the surveyed period. Crude MASLD mortality was lower in 2018-2021 but higher in 2022. Adjusted models showed year-to-year variation in the association with mortality. Including cirrhosis and HCC in the model showed that MASLD was associated with lower mortality, but the results depended on model adjustments. Older age, cardiovascular disease, chronic kidney disease, cancer, and cirrhosis were predictors of mortality among patients with MASLD. Conclusions The rate of MASLD among hospitalized adults in the United States rose from 2018 to 2022. Associations with mortality differed across years and depending on the analytic adjustments used. These findings at the discharge level should not be taken as evidence of either beneficial or harmful effects of MASLD.