S2689 Evaluating Outcomes in Patients With MASLD and Vitamin D Deficiency

Introduction: Vitamin D modulates the expression of receptors and mediators of inflammation in a cell-and-tissue-dependent manner. Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have been found to have lower levels of vitamin D compared to matched controls, with an inverse relationship observed between vitamin D levels and disease severity. This study aims to evaluate outcomes in patients with MASLD with normal vitamin D levels compared to patients with MASLD and vitamin D deficiency. Methods: This study utilized the TriNetX Research Network and included patients with MASLD or MASH between January 2006- January 2024. The cohorts were defined by a) normal vitamin D levels >30 ng/ml and b) vitamin D deficiency defined as <20 ng/ml. Propensity score matching was performed for the following covariates (age, sex, race, malignancy, heart failure, hypertension, chronic obstructive pulmonary disease, ischemic heart disease, chronic kidney disease). The primary outcomes were: mortality, hospital readmissions, intensive care unit (ICU) admissions, and development of cirrhosis at 1 year and 5-year follow-up. Results: A total of 12,204 patients with MASLD had normal vitamin D levels and 8,933 patients with MASLD had vitamin D deficiency. After 1:1 propensity matching 6,959 patients were included in each group. Patients with vitamin D deficiency were more likely to have hospital readmissions compared to patients with normal vitamin D levels at 1 and 5 years, 10% vs 6.0% (P = 0.01) and 15% vs 10% (P = 0.01), respectively. Rates of ICU care were increased in patients with vitamin D deficiency at 1 and 5 years, 2.6% vs 1.2% (P = 0.01) and 4.4% vs 2.4%, respectively. Progression to cirrhosis was not significant between groups. Mortality rates were increased in patients with vitamin D deficiency compared to patients with normal vitamin D levels at 1 and 5 years 1.5% vs 0.5% (P = 0.01) and 3.2% vs 1.3% (P = 0.01), respectively. Conclusion: Among patients with MASLD, those with vitamin D deficiency experienced significantly higher rates of hospital readmissions, ICU care, and all-cause mortality at both one- and 5-year follow-up compared to those with normal vitamin D levels. These results have identified vitamin D deficiency as a possible risk factor for worse outcomes in patients admitted with MASLD. Future studies are needed to further investigate vitamin D deficiency in patients with liver disease.