Prevalence and Outcomes of Metabolically Dysfunction–Associated Steatotic Liver Disease Among U.S. Hospitalized Patients: Insights From the Nationwide Inpatient Sample, 2018–2022

Background and Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is now the leading cause of chronic liver disease worldwide, yet national data on hospitalized patients remain limited. We aimed to examine the prevalence, demographic trends, and inpatient outcomes of MASLD hospitalizations in the United States. Methods: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) from 2018–2022, identifying adult hospitalizations with MASLD based on ICD-10 codes for hepatic steatosis or steatohepatitis in the presence of ≥1 metabolic risk factor (obesity, type 2 diabetes, hypertension, or dyslipidemia). Hospitalizations with alcohol-related, viral, or autoimmune liver diseases were excluded. Survey-weighted analyses were used to estimate national prevalence and assess associations with in-hospital mortality, length of stay (LOS), and total charges. Multivariable logistic regression adjusted for demographic, metabolic, cardiovascular, and hepatic comorbidities. Results : Among ~176 million weighted adult hospitalizations, 2.5 million (1.4%) were associated with MASLD. Prevalence rose from 1.03% in 2018 to 1.57% in 2022 (52% relative increase). MASLD admissions had higher unadjusted mortality (1.9%→3.6%), longer LOS (5.6→6.1 days), and higher mean charges ($69,220→$91,506). However, after multivariable adjustment, MASLD was associated with lower odds of in-hospital mortality across all years (aOR range, 0.70–0.79; p<0.001). Conclusions: Hospitalizations associated with MASLD have increased substantially in recent years, reflecting the growing national burden of metabolic disease. Despite higher crude mortality and resource use, MASLD was independently associated with lower adjusted inpatient mortality, likely due to coding patterns and the metabolic reserve (“obesity paradox”). Hospitalization represents a key opportunity for MASLD identification and linkage to longitudinal care.