B54-10 Association of Glucagon-Like Peptide-1 Agonist Use With Pulmonary and Infectious Complications in Non-Alcoholic Steatohepatitis

Introduction Nonalcoholic steatohepatitis (NASH) is frequently comorbid with metabolic disorders such as type 2 diabetes mellitus (T2DM), which increases vulnerability to systemic infections. Glucagon-like peptide receptor agonists (GLP-1 RAs) have demonstrated anti-inflammatory and weight-reducing effects; however, their impact on infectious pulmonary outcomes among patients with NASH remains unclear. Methods We conducted a retrospective cohort study using the TriNetX Research Network, comprising electronic medical records from 112 healthcare organizations. Two cohorts were identified: (1) adults (≥18 years) with NASH receiving GLP-1 RAs (ATC: A10BJ) and (2) those with NASH not exposed to GLP-1 RAs. Propensity score matching (1:1) was performed across demographics, comorbidities, and medications, yielding 39,592 patients per group. Outcomes analyzed included pneumonitis, pneumonia, ventilator use, ventilator-associated pneumonia (VAP), sepsis, empyema, lung abscess, ARDS, and bacteremia, assessed using ICD-10 codes. Risk ratios (RR), odds ratios (OR), and hazard ratios (HR) were calculated with Kaplan-Meier survival and log-rank testing. Results After matching, GLP-1 users demonstrated significantly lower risks of pneumonitis (RR 0.70, 95% CI 0.61-0.79), ventilator use (RR 0.78, 95% CI 0.71-0.86), sepsis (RR 0.83, 95% CI 0.78-0.87), empyema (RR 0.69, 95% CI 0.50-0.95), and bacteremia (RR 0.85, 95% CI 0.78-0.92). No significant differences were observed for pneumonia (RR 0.99), VAP (RR 1.09), ARDS (RR 0.96), or lung abscess (RR 0.96). Kaplan-Meier analyses revealed higher survival probabilities among GLP-1 users for pneumonitis (94.6% vs. 87.0%), sepsis (75.7% vs. 69.3%), and bacteremia (85.8% vs. 76.6%; all p < 0.001). Conclusion In this large, multicenter, propensity-matched analysis, GLP-1 receptor agonist use among patients with NASH was associated with significantly lower risks of severe pulmonary and systemic infections, including sepsis and bacteremia. These findings suggest potential immunometabolic benefits of GLP-1 therapy extending beyond hepatic and glycemic regulation, warranting prospective evaluation.