S2489 Prognostic Value of High-Sensitivity CRP Metabolic Associated Steatotic Liver Disease: A Propensity-Matched Analysis Using the TriNetX Research Network

Introduction: Metabolic associated steatotic liver disease (MASLD) is associated with increased cardiovascular risk and mortality, but the prognostic value of high-sensitivity C-reactive protein (hsCRP) in this population remains incompletely characterized. This study aimed to compare clinical outcomes between MASLD patients with elevated versus normal hsCRP levels. Methods: We performed a retrospective cohort study using the TriNetX Research Network, a global federated health research platform providing access to electronic medical records across 146 healthcare organizations. Patients with MASLD (International Classification of Diseases, Tenth Revision code K76.0) were stratified by hsCRP levels: elevated (≥3.10 mg/L) versus normal (≤3.00 mg/L). After propensity score matching for baseline demographics and comorbidities, cohorts of 39,419 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure, chronic kidney disease, atrial fibrillation, cerebrovascular disease, pulmonary embolism, acute myocardial infarction, pulmonary hypertension, coronary artery disease, diabetes mellitus, liver cirrhosis, and hypertension. Outcomes were analyzed using risk analysis and Kaplan-Meier survival analysis over a 5-year follow-up period. Results: In this propensity-matched cohort study, MASLD patients with elevated hsCRP demonstrated significantly higher all-cause mortality compared to those with normal hsCRP (11.0% vs 4.0%; HR 2.925, 95% CI 2.761-3.098; P < 0.001). Elevated hsCRP was also associated with increased incidence of heart failure (7.1% vs 4.4%; HR 1.718, 95% CI 1.612-1.831; P < 0.001), chronic kidney disease (7.9% vs 5.7%; HR 1.488, 95% CI 1.404-1.578; P < 0.001), atrial fibrillation and flutter (4.7% vs 3.3%; HR 1.531, 95% CI 1.421-1.649; P < 0.001), acute myocardial infarction (3.9% vs 2.2%; HR 1.868, 95% CI 1.715-2.035; P < 0.001), liver cirrhosis (4.4% vs 3.3%; HR 1.431, 95% CI 1.327-1.542; P < 0.001), and diabetes mellitus (12.6% vs 8.8%; HR 1.577, 95% CI 1.494-1.665; P < 0.001). Conclusion: In MASLD patients, elevated hsCRP levels are associated with significantly increased all-cause mortality and multiple adverse cardiovascular and metabolic outcomes. These findings suggest that hsCRP may serve as an important prognostic biomarker for risk stratification in MASLD patients and should be considered in clinical management algorithms.