Kim, Do Han

ABSTRACT Introduction Metabolic dysfunction‐associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors have shown benefits in reducing hepatic steatosis and liver‐related events in MASLD. This study aims to assess whether SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality and disease‐specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D). Methods A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT‐2 inhibitors were matched 1:1 with other glucose‐lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all‐cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox‐proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI). Results A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT‐2 inhibitors. Patients on SGLT‐2 inhibitors ( n = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT‐2 inhibitors cohort had statistically significantly lower risk of all‐cause mortality (HR: 0.58, 95% CI: 0.53–0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81–0.90) and MALO (HR: 0.88, 95% CI: 0.83–0.93). Conclusion SGLT‐2 inhibitors are associated with a reduced risk of all‐cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT‐2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample of adult patients discharged for AD. Patients were classified into six racial and ethnic groups: Caucasian, African American (AA), Hispanic, Asian, Native American (NA), and other. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for primary and secondary outcomes. Results: A total of 647,119 admissions with acute diverticulitis (AD) were identified. Most patients were Caucasian (about three-quarters), followed by Hispanics (11%), AA (9%), Asians (1%), Native Americans (<1%), and other (2%). Minority groups were generally younger than Caucasians and less likely to undergo colonoscopy or surgical procedures such as partial or total colectomy. In the multivariable analysis, both Hispanics and AA were less likely to present with complicated diverticulitis. Despite this, their hospitalizations were associated with higher overall charges and costs. No significant differences were found across groups in terms of inpatient mortality or the need for percutaneous abscess drainage. Conclusions: Hispanic and AA have higher healthcare- related charges and costs compared to Caucasians when admitted with AD. Further studies are needed to understand the healthcare-related spending variations seen in these groups despite them often having less complicated AD.