The Dynamic Evolution of Lipid Profiles Following Transjugular Intrahepatic Portosystemic Shunt in Patients With Liver Cirrhosis

ABSTRACT Aims Cirrhosis alters blood lipid profiles, yet how these changes differ according to disease etiology and respond to transjugular intrahepatic portosystemic shunt (TIPS) remains unclear. This preliminary study aimed to characterize lipid profile patterns across common cirrhosis types and evaluate their changes after TIPS. Methods In this retrospective study of 278 cirrhotic patients who underwent TIPS between January 2014 and December 2023, total cholesterol (TC), triglycerides (TG), high‑density lipoprotein cholesterol (HDL‑C), and low‑density lipoprotein cholesterol (LDL‑C) were analyzed before the procedure and during follow‑up periods of 1–3 months and 3–6 months post‑procedure. Patients were stratified by etiology (viral, alcoholic, autoimmune, cryptogenic) and Child‑Pugh grade. Multivariable analyses—including linear mixed‑effects models for longitudinal lipid changes, bidirectional stepwise linear regression, and LASSO regression with cross‑validation—were performed to identify factors influencing post‑TIPS lipid profile recovery. Results Lipid profiles varied significantly by cirrhosis etiology. Patients with cirrhosis due to autoimmune liver disease had the highest levels of TC (3.15 [2.65–4.03] mmol/L), HDL‑C (0.93 [0.73–1.06] mmol/L), and LDL‑C (1.68 [1.50–2.44] mmol/L), whereas viral cirrhosis showed the lowest TG levels (0.72 [0.60–0.93] mmol/L) and alcoholic cirrhosis had the lowest HDL‑C (0.64 [0.56–0.91] mmol/L) (all inter‑group p < 0.05). A significant declining trend was observed in TC, HDL‑C, and LDL‑C with worsening Child‑Pugh class (all p for trend < 0.05). After TIPS, HDL‑C increased progressively from 0.82 [0.63–1.01] mmol/L to 1.16 [0.98–1.33] mmol/L ( p for trend < 0.001). In contrast, TC, TG, and LDL‑C initially decreased at 1–3 months (TC: from 3.03 [2.63–3.67] mmol/L to 2.65 [2.13–3.32] mmol/L; TG: from 0.88 [0.65–1.21] mmol/L to 0.61 [0.51–0.80] mmol/L; LDL‑C: from 1.73 [1.36–2.11] mmol/L to 1.19 [0.97–1.57] mmol/L; all p < 0.05) and partially recovered by 3–6 months. TC, HDL‑C, and LDL‑C were positively correlated with albumin ( r = 0.470, p = 0.003; r = 0.470, p = 0.004; and r = 0.450, p = 0.006, respectively) and negatively correlated with albumin–bilirubin (ALBI) scores ( r = −0.600, p < 0.001; r = −0.490, p = 0.003; and r = −0.540, p < 0.001, respectively). In addition, TC and LDL‑C were negatively correlated with model for end‑stage liver disease (MELD) ( r = −0.410, p = 0.013; and r = −0.430, p = 0.008, respectively). Importantly, moderate‑to‑severe ascites independently predicted impaired recovery of TC ( β = −0.990, p = 0.016), TG ( β = −0.340, p = 0.002), and LDL‑C ( β = −0.710, p = 0.008) after TIPS. Conclusion Cirrhosis etiology and severity differentially shape lipid profiles. TIPS improves lipid profiles (particularly HDL‐C) in association with hepatic synthetic function. Ascites impairs post‐TIPS lipid recovery.