S2671 Association Between Polycystic Ovary Syndrome and Metabolic Dysfunction-Associated Steatotic Liver Disease Fibrosis Severity: A Retrospective Analysis

Introduction: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder associated with increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD). However, there is limited data comparing female patients with both PCOS and MASLD to those with MASLD alone. This study aims to evaluate differences in metabolic profiles and liver disease severity between these cohorts. Methods: In a single-center retrospective analysis, adult patients with MASLD were divided into 3 cohorts: (1) women with PCOS and MASLD (2) women with MASLD only (3) men with MASLD. The primary outcome was stage of liver fibrosis at time of MASLD diagnosis, assessed using non-invasive scores (NAFLD fibrosis score, FIB-4 Index), transient elastography, magnetic resonance elastography, and histology when available. Statistical methods included ANOVA, Pearson’s chi-squared, Kruskal-Wallis, multivariable logistic regression, and propensity score matching with Wilcoxon rank-sum testing. Results: 885 patients were included: 286 women with PCOS and MASLD, 521 women with MASLD alone, and 78 age-matched men with MASLD. Women with PCOS were diagnosed with MASLD at a significantly younger age (median 32.5 years) compared to women without PCOS (54.0 years) and men (36.0 years, P < 0.001), and had a higher median BMI (37.3 kg/m²). After adjusting for age and BMI in multivariable analysis, PCOS was not independently associated with more advanced liver disease. Notably, metformin use was associated with lower odds of advanced fibrosis (OR 0.59, 95% CI 0.36–0.98, P = 0.039), while diabetes was associated with increased odds (OR 2.34, 95% CI 1.23–4.46, P = 0.010). In propensity score-matched analysis controlling for age and diabetes, women with PCOS were diagnosed at a significantly lower fibrosis stage compared to MASLD-only women (W = 22,160, P = 4.35 × 10-16). Conclusion: Women with PCOS were diagnosed with MASLD at a significantly younger age and had higher BMI compared to non-PCOS controls, yet demonstrated a more favorable fibrosis profile compared to women and men with MASLD alone. PCOS was not independently associated with fibrosis severity after controlling for age and diabetes and metformin, a first-line therapy, was associated with a potential protective effect. These findings suggest that early screening for MASLD in patients with PCOS may identify liver disease at a more reversible stage, emphasizing the importance of monitoring and treatment in this high-risk population.