S223 Outcomes of Acute Pancreatitis in Lean vs Non-Lean MASLD Patients: A Nationwide Analysis

Introduction: Acute pancreatitis (AP) is a complex disease process characterized by pancreatic autodigestion resulting from pancreatic acinar cell damage. Host characteristics, risk stratification scoring systems, and clinical and laboratory evidence of response to therapy have been shown to predict outcomes in AP. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a key contributor to the severity and outcomes of AP. This study compares the clinical outcomes of AP in patients with lean vs non-lean MASLD. Methods: We identified adult patients (≥18 years) hospitalized with AP and a secondary diagnosis of MASLD from the National Inpatient Sample (2016 to 2020). Lean MASLD was operationalized as a subset of non-obese MASLD with a BMI <25 kg/m². We excluded patients with an ICD-10-CM history of alcohol-related liver disease and viral hepatitis. Outcomes, including mortality, organ failures, medical interventions, length of stay, and healthcare costs, adjusted for inflation to 2020 dollars, were analyzed using multivariable logistic and linear regression models, adjusting for demographic, comorbidities, clinical, and hospital factors. Results: We included 34,388 hospitalized patients with AP and MASLD, of whom 14,443 (42.0%) were non-lean. Annual admissions increased sharply in lean MASLD patients (5339 in 2016 to 8247 in 2020) compared to non-lean MASLD (2273 to 3635). Non-lean MASLD patients experienced higher inflation-adjusted hospital charges ($5,324.01; 95% CI: $3,273.42–$7,374.61, P < 0.01), a longer length of stay (adjusted increase 0.25 days; 95% CI: 0.12–0.39, P < 0.05), increased odds of respiratory failure (adjusted odds ratio [aOR] 4.60; 95% CI: 2.24–9.46, P < 0.01), sepsis (aOR 1.11; 95% CI: 1.00–1.23, P = 0.04), cholecystectomy (aOR 2.05; 95% CI: 1.92–2.19, P < 0.01), ERCP (aOR 1.42 95% CI: 1.11–1.82, P = 0.01) and MACE (aOR 1.19; 95% CI: 1.05-1.35, P < 0.01). Mortality did not differ significantly between groups (aOR 0.90; 95% CI: 0.69–1.17, P = 0.43). There was no statistically significant difference in decompensating liver events between lean and non-lean MASLD patients with cirrhosis (aOR 0.78; 95% CI: 0.61–1.00, P = 0.05). Conclusion: Our study suggests that lean MASLD patients with AP may experience a higher rate of hospital admissions and distinct clinical profiles, including a similar mortality risk compared to non-lean MASLD patients, indicating a complex relationship between AP outcomes and MASLD beyond BMI.