S2907 Analysis of the Outcomes of Septic Shock Patients With and Without MASLD: A United States Population-Based Cohort Study

Introduction: Septic shock is a severe and life-threatening manifestation of sepsis that carries a high risk of morbidity and mortality. The impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on septic shock prognosis remains underexplored. Identifying factors influencing outcomes in septic shock is critical for risk stratification and targeted management. This study aimed to assess the association between MASLD and in-hospital outcomes among patients with septic shock. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016–2020) and included adult patients (≥18 years) hospitalized with a primary diagnosis of septic shock, using International Classification of Diseases, Tenth Revision Clinical Modification codes. Patients were stratified by MASLD status; those with other chronic or acute liver diseases, including viral hepatitis, were excluded from the MASLD cohort. Patients were stratified by MASLD status; those with other chronic or acute liver diseases, including viral hepatitis, were excluded from the MASLD cohort. A 1:1 propensity score matching was performed based on demographics, comorbidities, and hospital characteristics. Outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, and acute respiratory distress syndrome (ARDS). Multivariable logistic regression was performed to assess adjusted associations between MASLD and outcomes. Results: The final sample included 17,382 patients (8,691 with MASLD and 8,691 without). Mean age was comparable (59.9 vs 59.8 years), with no significant racial differences (P = 0.717). Unadjusted mortality was lower in the MASLD group (27.8% vs 33.0%; P < 0.0001). However, on multivariable analysis, MASLD was associated with increased odds of in-hospital mortality (aOR 1.283, 95% CI: 1.203–1.369; P < 0.0001) and AKI (aOR 1.071, 95% CI: 1.005–1.143; P = 0.036). Conversely, MASLD was associated with lower odds of cardiac arrest (aOR 0.625, 95% CI: 0.554–0.705; P < 0.0001) and ARDS (aOR 0.834, 95% CI: 0.784–0.888; P < 0.0001). Conclusion: Among patients hospitalized with septic shock, MASLD was independently associated with higher odds of mortality and AKI, but paradoxically lower odds of cardiac arrest and ARDS. These findings underscore the need for further mechanistic studies and MASLD-specific risk stratification strategies in critical care settings.