S1996 Impact of MASLD/MASH on Crohn’s Disease Severity: A Global Federated EHR Analysis

Introduction: Crohn’s disease (CD) is a chronic inflammatory bowel disease often complicated by fistula formation, strictures, and intestinal obstruction. Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are increasingly identified in patients with CD. The impact of MASLD/MASH on CD-related outcomes remains unclear our aim is to evaluate whether MASLD/MASH is associated with an increased risk of Crohn’s disease complications. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adult patients with a diagnosis of CD were identified and stratified by the presence or absence of MASLD/MASH. Propensity score matching (1:1) was performed based on demographics and comorbidities, resulting in 2 balanced cohorts (n = 21,300 each). The primary outcome was a composite of CD complications, including intestinal obstruction, fistula formation, and intra-abdominal abscess. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess differences in outcomes. Results: Patients with MASLD/MASH had a higher incidence of CD complications than those without (14.3% vs 10.3%, P < 0.001), with a relative risk of 1.42 (95% CI: 1.32–1.46). Event-free survival at one year was significantly lower in the MASLD/MASH group (80.3% vs 85.7%, log-rank P < 0.001). The hazard ratio for developing complications was 1.44 (95% CI: 1.40–1.50). Conclusion: MASLD/MASH is significantly associated with increased risk of Crohn’s disease complications. These findings highlight the need for early identification and multidisciplinary management of CD patients with coexisting metabolic liver disease.