1582-P: Fasting Insulin as an Independent Predictor of Metabolic Dysfunction–Associated Steatohepatitis (MASH) Severity

Introduction & Objective: MASH is associated with metabolic syndrome; insulin resistance is a key driver of the disease. Advanced fibrosis (F3/F4) is the strongest predictor of major liver-related outcomes. We aimed to evaluate whether the level of fasting insulin (FI) predicts the histological severity of MASH. Methods: Using the EMMINENCE trial (NCT02784444), we examined patients with liver histology and FI data. 393 patients with available data were divided into 3 groups according to the FI tertiles: lower, ≤ 15.11 mIU/L; middle, 15.16 - 24.23 mIU/L; upper ≥ 24.25 mIU/L. Logistic regressions were performed to predict histological severity. Results: The upper tertile of FI was associated with a higher histological severity (fibrosis and hepatocyte ballooning, table). This was consistent with more severe patient characteristics such as higher liver enzymes, triglycerides, fibrosis biomarkers, HbA1c, and liver stiffness measurement (Table). The upper tertile was predictive of advanced fibrosis and ballooning in univariate analysis (p