S2656 Mortality Benefit of Statin Exposure in Patients With Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis and Spontaneous Bacterial Peritonitis

Introduction: Spontaneous bacterial peritonitis (SBP) is a complication of decompensated cirrhosis, contributing significantly to the morbidity and mortality associated with chronic liver disease. Statins which have been previously used for cardiovascular disease risk reduction have emerged as a beneficial agent in cirrhosis given their anti-inflammatory properties. Motzkus-Feagans et al demonstrated reduced infection risks among statin users in a cohort of U.S. Veterans with cirrhosis, suggesting that statins may offer protection against cirrhosis-related complications. While their role in preventing hepatic decompensation is increasingly recognized, a gap exists in the understanding of how statins influence outcomes in specific infections such as SBP. This study aims to address this gap by exploring the association between statin use and SBP-related mortality in patients with MASH cirrhosis. Methods: Data from the US Collaborative Network-TriNetX was used to evaluate the impact of statins on patients aged 18 years and older with MASH cirrhosis hospitalized for SBP between January 1, 2013 and January 1, 2023 using relevant International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients were divided into 2 cohorts: those with concurrent statin use, and those without. Both cohorts were propensity score matched based on demographics, comorbidities such as diabetes and hypertension and biochemical values such as serum albumin. They were followed for 30 days post-hospitalization to assess the primary outcome of mortality. Secondary outcomes included sepsis, shock and acute kidney injury (AKI). Results: Each cohort consisted of 836 patients after propensity-score matching with similar characteristics. The mean age after matching was 66 ± 11 years with 51% being woman. Our analysis found that within 30 days post-hospitalization, the cohort without concurrent statin exposure had a significantly higher odds of mortality (HR: 1.56, 95% CI: 1.22-2.00, P: 0.0004). There was no significant difference in the occurrence of sepsis, shock or AKI. Conclusion: Our study demonstrates a significant mortality benefit associated with concurrent statin exposure in patients with MASH cirrhosis hospitalized for SBP. Prior studies have primarily emphasized the role of statins in prevention of decompensated cirrhosis; however, our findings highlight that statins may also confer a survival advantage even after decompensation has occurred. Further longitudinal studies are needed to explore the therapeutic role of statins in decompensated cirrhosis.