Outcomes of Acute Pancreatitis in Lean Vs. Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease (Masld) Patients: A Nationwide Analysis

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a key contributor to the severity and outcomes of acute pancreatitis (AP). This study compares the clinical outcomes of AP in patients with lean versus non-lean MASLD. Methods: We identified adult patients hospitalized with AP and a secondary diagnosis of MASLD from the National Inpatient Sample (NIS 2016-2020). Outcomes, including mortality, organ failures, and healthcare utilization, were analyzed using logistic and linear regression models, adjusting for demographic, clinical, and hospital factors. Results: We included 34,388 hospitalized patients with AP and MASLD, of whom 14,443 (42.0%) were non-lean. Annual admissions increased sharply in lean MASLD patients (5339 in 2016 to 8247 in 2020) compared to non-lean MASLD (2273 to 3635). Non-lean MASLD patients experienced higher inflation-adjusted hospital charges ($5,324.01; 95% CI: $3,273.42–$7,374.61, P < 0.01), a longer length of stay ((adjusted increase 0.25 days; 95% CI: 0.12–0.39, P < 0.05), increased odds of respiratory failure (aOR 4.60; 95% CI: 2.24–9.46, P <0.01), sepsis (aOR 1.11; 95% CI: 1.00–1.23, P = 0.04), cholecystectomy (aOR 2.05; 95% CI: 1.92–2.19, P < 0.01), ERCP (aOR of 1.42 95% CI: 1.11–1.82, P = 0.01). Mortality did not differ significantly. (aOR 0.90; 95% CI: 0.69–1.17, P = 0.43). Conclusion: Our study suggests that lean MASLD patients with AP may experience a higher rate of hospital admissions and distinct clinical profiles, including a similar mortality risk compared to non-lean MASLD patients, indicating a complex relationship between AP outcomes and MASLD beyond BMI.