P2865 - Causes of Death, Mortality Rates, and the Role of Socio-Demographic Risk Factors and Biomarkers in Metabolic Dysfunction-Associated Steatohepatitis Mortality in More Than 18,000 Real World Patients From the United States

Jörn M. Schattenberg, MD¹, Claudio Sartini, PhD², Ronald Herrera, PhD², Mireia Raluy, MSc³, Mark Yates, PhD, MBChB⁴, Ramy Younes, MD, PhD^2
1Saarland University Medical Center, Homburg, Saarland, Germany; ²Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Rheinland-Pfalz, Germany; ³Evidera, Data Analytics, Sundbyberg, Stockholms Lan, Sweden; ⁴Evidera, Data Analytics, London, England, United Kingdom

Introduction: Past real-world studies of mortality risks in patients with metabolic dysfunction-associated steatohepatitis (MASH) were limited by sample size, time of data collection, being single center, biopsy based, or broad focus on steatotic liver disease. This study investigates mortality rates, causes of death, and the role of socio-demographic risk factors and biomarkers that could be associated with mortality in a large real-world MASH population.

Methods: US Optum Market Clarity linked claims and electronic health records from 2016-2021 were used to identify MASH patients, defined by the first ICD10 diagnosis code (K75.81 Nonalcoholic steatohepatitis) recorded and AST, ALT, and platelet counts within 3 months before and after the index date. Patients with cancer, bariatric surgery, T1D, and alcohol-related or other chronic liver diseases were excluded. Risk factors included age, sex, race, region, comorbidities, FIB-4 fibrosis score and routinely collected biomarkers (LDL cholesterol, triglycerides, eGFR, and HbA1c). Associations between risk factors and mortality was estimated in survival models. In stratified sub-population analysis, crude mortality incidence rates were calculated in MASH patients with BMI ≥25 and T2D vs patients with BMI ≥25 without any liver disease and T2D.

Results: 18,710 MASH patients (mean age 44 years, 54% female, 80% white, 95% with BMI ≥25, 52% with T2D) were followed-up for 6.5 years after diagnosis (mean 3 years): 1465 patients died (70% from cardiovascular disease (CVD) and 17% from liver-related causes). African Americans (vs white) and South residents (vs North-East) had higher all-cause mortality rates (HR: 1.12 and 1.56 respectively). An eGFR of < 60mL/min/1.73m² and having ≥3 comorbidities (vs none) were also associated with increased mortality (HR: 3.01 and 1.93 respectively). The mortality incidence rate was 31 per 1000 py in MASH with BMI ≥25 and T2D (5 times higher than those with BMI ≥25 without liver disease/T2D) and 25 per 1000 py in the overall MASH cohort.

Discussion: Mortality incidence rates are especially high in MASH patients living with overweight/obesity and T2D. Higher mortality in African Americans and South residents suggest socio-demographic differences; this may be due to less access to health care. CVD risk reduction in patients with MASH will be crucial to improve outcomes. Also, the eGFR-mortality association signaled that kidney disease prevention is important.



This encore was originally presented at EASL 2024.


Disclosures:


Jörn M. Schattenberg, MD¹, Claudio Sartini, PhD², Ronald Herrera, PhD², Mireia Raluy, MSc³, Mark Yates, PhD, MBChB⁴, Ramy Younes, MD, PhD². P2865 - Causes of Death, Mortality Rates, and the Role of Socio-Demographic Risk Factors and Biomarkers in Metabolic Dysfunction-Associated Steatohepatitis Mortality in More Than 18,000 Real World Patients From the United States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.