S2495 Long-Term Aspirin Use Is Associated With Favorable Clinical Outcomes in Alcohol-Associated Liver Disease: A National Analysis

Introduction: Alcohol-associated liver disease (ALD) is a major driver of liver-related morbidity and mortality in the United States, with limited pharmacologic options to modify its clinical course. Recent studies have demonstrated favorable outcomes with aspirin use in metabolic dysfunction-associated steatotic liver disease (MASLD), attributed to its anti-inflammatory and antiplatelet properties. Given similar mechanisms of injury in ALD we hypothesize that aspirin use may confer comparable benefits in this population. This study evaluates the association between long-term aspirin use and clinical outcomes in ALD using the Nationwide Inpatient Sample. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) data from 2016 to 2021. Patients with ALD were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and stratified by long-term aspirin use. Demographic variables, hospital characteristics, socioeconomic indicators, and comorbidity burden were collected. The primary outcomes included in-hospital mortality, ICU admission, shock, sepsis, peritonitis, acute kidney injury (AKI), and length of stay (LOS). Multivariable logistic regression was used to assess associations between aspirin use and outcomes, adjusting for potential confounders such as age, sex, race, insurance status, and Charlson Comorbidity Index. Results: Among 3,303,108 ALD cases, 180,564 (5.47%) were long-term aspirin users. Aspirin users were older (61.5 vs 53.3 years), predominantly man (78%), and more likely to be White (71%) and Medicare-insured (49%). In adjusted analyses, aspirin use was associated with significantly lower odds of in-hospital mortality (adjusted odds ratio [aOR] 0.45; 95% CI: 0.42–0.48; P < 0.001), ICU admission (aOR 0.59; 95% CI: 0.55–0.63; P < 0.001), shock (aOR 0.55; 95% CI: 0.51–0.58; P < 0.001), sepsis (aOR 0.63; 95% CI: 0.61–0.66; P < 0.001), peritonitis (aOR 0.50; 95% CI: 0.46–0.54; P < 0.001), and AKI (aOR 0.78; 95% CI: 0.76–0.81; P < 0.001). Aspirin users also had a shorter LOS (5.5 vs 6.2 days; P < 0.001). Conclusion: In this large national cohort, long-term aspirin use was associated with significantly improved clinical outcomes in patients with ALD, including reduced mortality and critical illness. Despite a higher comorbidity burden, aspirin users experienced better outcomes. These findings support the potential therapeutic role of aspirin in ALD and emphasize the need for prospective studies to further evaluate its efficacy and safety in this high-risk population.