Clinical features and associated factors for clinically significant portal hypertension in patients with histologically early-stage primary biliary cholangitis

BACKGROUND Clinically significant portal hypertension (CSPH) is traditionally associated with advanced liver fibrosis, but its occurrence and predictors in histologically early stage primary biliary cholangitis (PBC) remain unclear.AIM To identify clinical features and independent risk factors for CSPH in patients with biopsy proven early stage (Scheuer stage I-II) PBC, facilitating early recognition and targeted intervention.METHODS This retrospective study enrolled 110 patients with histologically early-stage PBC at Beijing Ditan Hospital (2020-2023).Patients were divided into CSPH (n = 27) and non CSPH (n = 83) groups based on Baveno VII criteria.Demographic, laboratory, elastographic, and ultrasonographic data were compared.Multivariate logistic regression was used to determine independent predictors. RESULTSBoth groups were predominantly middle-aged women.The CSPH group had significantly lower white blood cell count, hemoglobin, platelet, albumin, cholinesterase, and low-density lipoprotein cholesterol levels, and higher total bilirubin, alkaline phosphatase, and total bile acid levels (all P < 0.05).Drug allergy history (29.6% vs 8.4%, P < 0.05) and histological stage II (63.0%vs 39.8%, P < 0.05) were more frequent in the CSPH group.Autoantibody profiles (anti-mitochondrial antibodies, antinuclear antibody, anti-centromere, anti-sp100, anti-gp210) and immunoglobulin levels did not differ between groups.Imaging showed larger portal vein diameter and higher liver 4 / 29 stiffness in the CSPH group (both P < 0.05).Multivariate analysis identified drug allergies [odds ratio (OR) = 5.948, 95%CI: 1.494-23.675,P = 0.011] and main portal vein diameter (OR = 2.563, 95%CI: 1.635-4.017,P < 0.001) as independent factors associated with CSPH.CONCLUSION CSPH is not rare in histologically early-stage PBC, especially at stage II, and is accompanied by worse liver function and cytopenias.Drug allergy history and increased portal vein diameter are independently associated with CSPH, whereas common autoantibodies appear unrelated.These findings may help stratify early-stage PBC patients at risk of CSPH, though prospective validation is warranted.