Diagnostic Performance of Serum Lipid Parameters for Identifying Severe Liver Cirrhosis: A Receiver Operating Characteristic Analysis

Background: Liver cirrhosis is characterized by progressive hepatic tissue disruption leading to portal hypertension and impaired metabolic capacity. Because the liver synthesizes, remodels, and clears serum lipids, cirrhosis alters circulating lipid homeostasis. This study aimed to evaluate fasting serum lipid profile abnormalities in cirrhotic patients and determine their diagnostic and prognostic performance in identifying severe liver disease. Material and Methods: This analytical cross-sectional study included 103 adult patients with confirmed liver cirrhosis admitted to the Department of General Medicine, Koppal Institute of Medical Sciences Teaching Hospital, Koppal, between July 2023 and January 2024. Fasting lipid profiles—total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG)—were measured and correlated with Child-Pugh classification (Classes A, B, and C) and Model for End-Stage Liver Disease (MELD) scores. Receiver Operating Characteristic (ROC) curve analyses were performed. Results: The study population was predominantly male (80.6%) with a mean age of 44.2 ± 11.8 years. Alcoholic etiology predominated (93.2%), and 48.5% of patients were classified as Child-Pugh Class C. Lipid parameters showed a significant progressive decrease across Child-Pugh Classes A, B, and C: TC (164.3, 151.7, 138.4 mg/dL; p < 0.001), HDL-C (52.6, 45.1, 39.4 mg/dL; p < 0.001), and LDL-C (86.4, 71.3, 58.2 mg/dL; p < 0.001). Strong negative correlations were observed between lipid parameters and both Child-Pugh and MELD scores. ROC curve analysis demonstrated robust discriminatory performance for detecting severe cirrhosis (Child-Pugh Class C or MELD ≥ 18), yielding Area Under the Curve (AUROC) values of 0.76 for TC, 0.75 for LDL-C, and 0.73 for HDL-C. Conclusion: Serum lipid parameters, particularly total cholesterol, LDL-C, and HDL-C, decline in direct proportion to advancing hepatic decompensation. Serum lipid profiling offers objective, accessible, and high-performing non-invasive biomarkers for assessing disease severity and stratifying risk in patients with liver cirrhosis.

Keywords: Liver cirrhosis, Lipid profile, Total cholesterol, HDL-C, MELD score, Child-Pugh score, ROC curve, Diagnostic performance.