The Impact of Masld on Autoimmune Hepatitis Outcomes: A Nationwide Analysis of 2880 Records.

Despite the growing recognition of autoimmune hepatitis (AIH) - Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) overlap, studies today are limited by small sample sizes. This study aimed to investigate the impact of MASLD on the outcomes of patients with AIH using large-scale real world data. This cohort study used the TriNetX research network to identify U.S. adults (≥18 years) with AIH. Patients were stratified into those with MASLD (AIH-MASLD cohort), and controls (AIH without MASLD). Propensity score matching (1:1) between AIH-MASLD and controls accounted for demographics, comorbidities, and treatments. Outcomes were classified as short-term (within 1 year after diagnosis) or long-term (within 10 years) outcomes. Among 4,798 records with AIH, 1,440 AIH-MASLD patients were propensity matched with 1,440 controls. AIH-MASLD patients demonstrated reduced one-year odds of all-cause mortality (HR = 0.66, 95%CI: 0.44 - 0.98), and immunosuppressive medication use (HR = 0.69, 95%CI: 0.63 - 0.76), along with increased 10-year odds of cirrhosis (HR = 1.22, 95%CI: 1.06 - 1.40) and hepatocellular carcinoma (HR = 2.03, 95%CI: 1.09 - 3.78) compared to controls. In summary, our study using real-world evidence showed a significant association between MASLD and worse clinical outcomes in patients with AIH. Future efforts should be targeted towards facilitating early detection and management of MASLD in AIH patients.