S2490 Comparative Outcomes of Alcoholic vs Metabolic Associated Steatotic Liver Disease: A Large-Scale Propensity-Matched Analysis Using the TriNetX Research Network

Introduction: Fatty liver disease represents a significant global health burden, with both alcoholic fatty liver disease (AFLD) and metabolic associated steatotic liver disease (MASLD) contributing to substantial morbidity and mortality. While both conditions share similar hepatic manifestations, their natural history and associated complications may differ significantly. This study aimed to compare clinical outcomes between patients with AFLD and MASLD using real-world data. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, a global federated health research platform providing access to electronic medical records across 145 healthcare organizations. Patients diagnosed with alcoholic fatty liver (International Classification of Diseases, Tenth Revision code K70.0) were compared to those with MASLD code K76.0). After propensity score matching for baseline demographics and comorbidities, cohorts of 37,592 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure, chronic kidney disease, atrial fibrillation, cerebrovascular disease, acute myocardial infarction, liver cirrhosis, diabetes mellitus, and hospital admissions. Outcomes were analyzed using risk analysis and Kaplan-Meier survival analysis over a 5-year follow-up period. Results: Patients with AFLD demonstrated significantly higher all-cause mortality compared to MASLD patients (12.8% vs 5.9%; HR 2.336, 95% CI 2.221-2.457; P > 0.001). AFLD was associated with increased risk of liver cirrhosis (14.1% vs 4.5%; HR 3.498, 95% CI 3.300-3.708; P > 0.001), heart failure (5.9% vs 4.4%; HR 1.453, 95% CI 1.359-1.552; P > 0.001), chronic kidney disease (6.3% vs 5.2%; HR 1.308, 95% CI 1.229-1.392; P > 0.001), and hospital admissions (17.5% vs 11.6%; HR 1.644, 95% CI 1.574-1.717; P > 0.001). Interestingly, MASLD patients had higher rates of incident. Conclusion: AFLD is associated with significantly worse clinical outcomes compared to MASLD, including higher mortality, increased risk of liver cirrhosis, cardiovascular complications, and healthcare utilization. These findings underscore the importance of alcohol cessation programs and intensive monitoring for AFLD patients. The higher diabetes risk in MASLD patients highlights the metabolic nature of this condition and the need for comprehensive metabolic management.