S1171 Elevated Ferritin Is Associated With Increased Prevalence of Cirrhosis but Not Congestive Heart Failure Among Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

Introduction: Hyperferritinemia is common in patients with metabolic dysfunction associated fatty liver disease (MAFLD). Elevated ferritin levels are also associated with elevated AST/ALT levels and non-invasive markers of fibrosis. The purpose of our study was to explore the relationship between hyperferritinemia and prevalence of cirrhosis in patients with MAFLD after adjustment for other cirrhosis risk factors. Methods: We conducted a cross sectional analysis of patients with MAFLD seen at Michigan Medicine between 2010-2021. A diagnosis of MAFLD required hepatic steatosis on biopsy, imaging, or vibration-controlled transient elastography in addition to overweight, diabetes or two of dyslipidemia, pre-diabetes, hypertension. Patients with baseline malignancy aside from non-melanoma skin cancer were excluded. The primary predictor was ferritin level, which was dichotomized with a cutoff of 300 or 450mcg/L for women or men respectively (1.5 times the upper limit of normal). The primary outcomes were cirrhosis and congestive heart failure (CHF) diagnosed < 365 after the MAFLD index date. We conducted logistic regression to characterize the association between ferritin and cirrhosis or CHF adjusted for confounders. Results: We included 7,705 patients with MAFLD, of whom 1,762 (22.9%) had elevated ferritin. Patients with elevated ferritin were older, more often male, and more often had FIB-4 score >3.25 (29 vs 9%), NFS >0.676 (35 vs 22%), and AST > ULN (80 vs 62%). Elevated ferritin was associated with increased prevalence of cirrhosis with odds ratio (OR) 1.24 (95% CI 1.06-1.45, p< .007) after adjusting for gender, age, diabetes, hypertension, dyslipidemia, and AST levels (Table). As expected, diabetes (OR) 1.93 (95% CI 1.66-2.25, p< 0.0001) and AST levels >ULN (OR) 2.87 (95% CI 2.40-3.43, p< 0.0001) were independently associated with increased prevalence of cirrhosis. High ferritin was not associated with increased prevalence of CHF after adjusting for other variables (OR) 1.04 (95% CI 0.84-1.30, p=0.71). However, diabetes (OR) 1.58 (95% CI 1.30-1.92, p< 0.0001), and hypertension (OR) 3.79 (95% CI 2.82-5.08, p< 0.0001) were expectedly associated with increased prevalence of CHF in this cohort. Conclusion: Elevated ferritin is associated with increased prevalence of cirrhosis but not CHF in patients with MAFLD. Hyperferritinemia may be a poor prognostic indicator in MAFLD. Table 1. - Unadjusted and adjusted predictors of prevalent cirrhosis Variable Unadjusted odds ratio P-value Adjusted odds ratio P-value High ferritin 1.51 (1.30-1.76) < 0.0001 1.24 (1.06-1.45) 0.0068 Age (per year) 1.02 (1.02-1.03) < 0.0001 1.03 (1.02-1.03) < 0.0001 Male gender 0.99 (0.86-1.13) 0.86 0.92 (0.80-1.06) 0.25 Diabetes 1.66 (1.45-1.91) < 0.0001 1.93 (1.66-2.25) < 0.0001 Hypertension 1.24 (1.07-1.42) 0.0030 1.13 (0.96-1.33) 0.15 Dyslipidemia 0.73 (0.63-0.84) < 0.0001 0.47 (0.40-0.55) < 0.0001 AST >ULN 2.70 (2.27-3.21) < 0.0001 2.87 (2.40-3.43) < 0.0001