Impact of MASLD in-hospital mortality in patients with cholangiocarcinoma: A nationwide analysis.

Abstract

e16217 Background: Cholangiocarcinoma is an aggressive hepatobiliary malignancy frequently requiring hospitalization due to advanced disease and treatment-related complications. Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common chronic liver condition and a recognized risk factor for hepatobiliary cancers, characterized by metabolic and inflammatory disturbances that may influence short-term inpatient outcomes. However, the impact of MASLD on hospitalization outcomes in cholangiocarcinoma remains poorly defined. Using a nationally representative database, we evaluated the association between MASLD and in-hospital mortality, complications, and healthcare utilization among patients hospitalized with cholangiocarcinoma. Methods: A retrospective cohort study was conducted using the 2019–2023 National Inpatient Sample (NIS) database. Adult patients (≥18 years) hospitalized with cholangiocarcinoma were identified using ICD-10 codes and stratified based on the presence of MASLD. The primary outcome was in-hospital mortality, and secondary outcomes included race, length of stay (LOS), hospital charges, infections and gastrointestinal complications, and other clinical outcomes. Results: A total of 189,820 hospitalized patients with cholangiocarcinoma were identified, of whom 6,425 (3.4%) had MASLD. Affected patients were younger (mean age 66 vs 68 years; Coefficient: -1.8; P < 0.001), predominantly White (n = 4,498; 70%) with equal sex distribution (50% Female). Compared with non-MASLD, patients with MASLD were associated with significantly lower in-hospital mortality (5% vs 7%; OR: 0.72; P < 0.05) but higher gastrointestinal adverse events (27% vs 23%; OR: 1.29; P < 0.001), including acute pancreatitis (6% vs 4%; OR: 1.5; P < 0.05), peptic ulcer diseases (4% vs 2%; OR: 1.5; P < 0.001), and hepatic failure (8% vs 5%; OR: 1.5; P < 0.001). No significant differences were observed in GI bleed, diarrhea, or nausea. Hospital charger costs were higher among MASLD patients ($106,994 vs $95,531; Coefficient: 11,462; P < 0.05), while LOS did not differ significantly between groups (Coefficient: 0.212 days; P = 0.260). Conclusions: MASLD was associated with lower in-hospital mortality despite higher hospital charges and increased gastrointestinal adverse events. MASLD patients had higher rates of acute pancreatitis, peptic ulcer disease, and hepatic failure, while no differences were observed in gastrointestinal bleeding, diarrhea, or nausea. Length of stay was similar between groups. These findings indicate a heterogeneous association between metabolic liver disease and short-term inpatient outcomes in cholangiocarcinoma and support the need for further investigation.