Metabolic dysfunction-associated steatotic liver disease increases the risk of acute kidney injury in septic shock: A United States population-based study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with systemic inflammation and potentially influences the outcomes of critical illness. However, its impact on septic shock remains poorly defined. We aimed to evaluate the association between MASLD score and outcomes in patients with septic shock. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2020) and included adults (aged ≥ 18 years) with septic shock. Patients were stratified according to the MASLD status, and those with acute liver diseases were excluded. A 1:1 propensity score matching was performed based on the demographics, comorbidities, and hospital characteristics. Outcomes included mortality, acute kidney injury (AKI), pulmonary embolism, cardiac arrest, acute respiratory distress syndrome, and transfusion requirements. Multivariable logistic regression was performed to assess the association between the MASLD score and outcomes. Among the 17,382 patients with septic shock, 8691 had MASLD. The incidence of AKI was higher in the MASLD compared than in the non-MASLD (69.9% vs 68.4%, P = .036). In contrast, MASLD was associated with lower mortality (27.8% vs 33.0%; P < .0001), cardiac arrest (5.3% vs 8.2%; P < .0001), acute respiratory distress syndrome (32.3% vs 36.4%; P < .0001), pulmonary embolism (2.2% vs 4.2%; P < .0001), and transfusion requirements (19.6% vs 21.3%, P = .005). MASLD had higher odds of AKI (adjusted odds ratio 1.071; 95% confidence interval, 1.005-1.143; P = .036), particularly in black patients (adjusted odds ratio 1.327; 95% confidence interval, 1.072-1.642; P = .0092). MASLD was associated with higher odds of AKI but paradoxically lower odds of other adverse outcomes. Further research is required to elucidate the mechanisms linking MASLD to septic shock outcomes.