Incidence, Risk Factors and Outcomes of Early Post-Transjugular Intrahepatic Portosystemic Shunt Hyperbilirubinemia

To determine the incidence, risk factors, and outcomes of early post-transjugular intrahepatic portosystemic shunt (TIPS) hyperbilirubinemia in cirrhotic patients.

In this retrospective single-center study, 1,404 cirrhotic patients who underwent TIPS were analyzed. Patients with early post-TIPS hyperbilirubinemia (total bilirubin [TB] ≥ 5 mg/dL within 1 week after TIPS; primary predictor) were classified as Group A, and those without it were classified as Group B. Threshold effect analysis was used to identify the optimal cut-off for the change in TB (ΔTB, exploratory parameter), followed by Fine-Gray modeling.

Early post-TIPS hyperbilirubinemia occurred in 67 patients (4.8%). The cumulative incidence of mortality was higher in Group A than in Group B at 1-year (37.3% vs. 7.7%), 3-year (49.7% vs. 19.8%), and 5-year (49.7% vs. 30.3%) (p < 0.001). Multivariate analysis identified early post-TIPS hyperbilirubinemia (subdistribution hazard ratio [sHR] =3.03, p < 0.001), age (sHR = 1.05, p < 0.001), albumin level (sHR = 0.96, p < 0.001), MELD score (sHR = 1.05, p = 0.005), and Hepatocellular carcinoma (sHR = 1.77, p < 0.001) as independent predictors of mortality. ΔTB was independently associated with mortality whether analyzed as a continuous variable (sHR = 1.19, p < 0.001) or dichotomized at 2.98mg/dL (sHR = 2.64, p < 0.001). Rounding the cutoff to 3 mg/dL did not materially alter the association (sHR = 2.58, p < 0.001).

TB ≥ 5 mg/dL within the first week after TIPS, or ΔTB ≥ 2.98mg/dL (approximately 3 mg/dL), was independently associated with mortality.