Abstract
AIMS: To evaluate the impact of diabetes on in-hospital outcomes among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who were hospitalized for cardiovascular disease (CVD). METHODS: We conducted a retrospective cross-sectional study using data from the nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination, from April 2012 to March 2023. A total of 10,614 patients with MASLD hospitalized for CVD were identified, of whom 4550 (42.9%) had diabetes. The primary outcome was in-hospital mortality, and secondary outcomes were major cardiac and non-cardiac complications. RESULTS: The median age was 66 years, and 66.9% were male. Compared with patients without diabetes, those with diabetes had higher rates of ischaemic heart disease (35.5% vs. 30.8%), acute coronary syndrome (18.8% vs. 16.9%) and heart failure (27.3% vs. 25.4%) (all p < 0.05). In-hospital mortality (5.6% vs. 3.3%; p < 0.001) and overall complication rates (23.6% vs. 19.7%; p < 0.001) were significantly greater in the diabetes group, driven mainly by cardiac events (16.8% vs. 10.5%; p < 0.001). Multivariable logistic regression confirmed diabetes as an independent predictor of in-hospital mortality (odds ratio, 1.99; 95% confidence interval, 1.60-2.47; p < 0.001). CONCLUSIONS: Diabetes was associated with higher in-hospital mortality and complication rates among patients with MASLD hospitalized for CVD. Stratification of MASLD by metabolic phenotype, particularly in the presence of diabetes, may help improve risk assessment and inform more personalized clinical management in this population.