Investigating the Unexpected Link: Hospitalization Outcomes of MASLD Patients with Upper Gastrointestinal Bleeding

Investigating the Impact of MASLD on Outcomes in Upper GI Bleeding

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is on the rise and has been linked to worse outcomes in conditions such as congestive heart failure, chronic obstructive pulmonary disease, and pneumonia.

Emerging evidence suggests that in cases of upper gastrointestinal bleeding (UGIB), MASLD may be associated with increased mortality and higher risks of respiratory and liver failure.

However, paradoxical trends have also been observed, including lower rates of myocardial infarction (MI) and shorter hospital stays among MASLD patients.

Given the uncertainty surrounding the relationship between MASLD and UGIB outcomes, this study seeks to investigate whether MASLD contributes to adverse outcomes in patients hospitalized for UGIB.

Retrospective Analysis of UGIB in Patients with and Without MASLD Using National Inpatient

A retrospective study was performed using data from the 2020 National Inpatient Sample (NIS) database.

The study included patients aged 18 and older who were hospitalized with upper gastrointestinal bleeding (UGIB).

Demographic characteristics and hospitalization details were collected and compared between patients with metabolic-associated steatotic liver disease (MASLD) and those without MASLD.

Additionally, the rates of complications were analyzed and compared across the two groups.

Key Findings: MASLD and UGIB Outcomes

Patient Demographics:

Total patients hospitalized with UGIB: 129,122.

Patients with MASLD: 6,782 (5.3%).

Patients without MASLD: 122,340 (94.7%).

Mortality and Hospitalization Outcomes:

MASLD patients had significantly lower mortality rates (3.1% vs. 5.3%, p<0.001).

Shorter average hospital stays (5.52 vs. 6.49 days, p<0.001).

Reduced hospitalization costs ($75,665 vs. $87,908, p<0.001).

Complication Rates:

MASLD patients were less likely to develop:

Sepsis.

Respiratory failure.

Renal failure.

Myocardial infarction (MI).

Pulmonary embolism.

Key Insight

This study reveals an unexpected association between MASLD and improved outcomes in patients hospitalized with upper gastrointestinal bleeding (UGIB).

The underlying mechanisms driving this relationship remain largely speculative and are likely multifactorial.

One possible explanation is the hypercoagulable state frequently observed in individuals with hepatic steatosis, which may help reduce mucosal bleeding and prevent clinical decompensation during UGIB episodes.

Additionally, alterations in gut microbiota commonly associated with MASLD, such as decreased abundance of Lachnospiraceae and Ruminococcaceae, may play a role in this phenomenon.

These microbial species are typically elevated in individuals experiencing gastrointestinal bleeding, potentially influencing the observed outcomes.

By - Eeshan Aggarwal

Reference: Hepatology. Volume 80, Issue S1. Abstract Supplement for The Liver Meeting by the American Association for the Study of Liver Diseases (AASLD), November 15-19, 2024, San Diego, CA.