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Xue Fang Li,1 Shi Rong Liu,2 Jin Jin Li,1 Ning Liu,2 Hui Min Li,3 An Ning Ge,4 Liang Liang Wang,5 Xie Min Dong,1 Hui Wang,1 Ju Liu,1 Lin Zhang,1 Hao Dong Zhang,1 Wei Gou1 1Department of Metabolic Liver Disease, Qingdao Sixth People’s Hospital, Qingdao City, Shandong Province, People’s Republic of China; 2Infectious Diseases department, People’s Hospital of Qu fu City, Qufu City, Shandong Province, People’s Republic of China; 3Infection Department, Jiaozhou Branch of Shanghai East Hospital Tongji University, Qingdao City, Shandong Province, People’s Republic of China; 4Department of Infectious Diseases, People’s Hospital of Rizhao City, Rizhao City, Shandong Province, People’s Republic of China; 5Medical Intervention Department, Qingdao Sixth People’s Hospital, Qingdao City, Shandong Province, People’s Republic of ChinaCorrespondence: Wei Gou, Department of Metabolic Liver Disease, Qingdao Sixth People’s Hospital, Qingdao City, Shandong Province, People’s Republic of China, Tel +86-15666687727, Fax +86-532-81636699, Email gouwei@qdu.edu.cnObjective: To investigate the risk factors for the development of portal hypertension in patients with decompensated cirrhosis and analyze their prognosis.Methods: Patients with decompensated cirrhosis who were admitted to our hospital and Qu fu People’s Hospital from June 2022 to June 2023 were included in this study. Among them, there were 45 male and 15 female patients, with a median age of 56 (range: 35– 77) years. A comparative analysis was performed between Group A (hepatic venous pressure gradient, HVPG < 16 mmHg) and Group B (HVPG ≥ 16 mmHg) patients, along with various clinical outcomes. Multivariate analysis was conducted to explore the risk factors influencing the occurrence of portal hypertension and adverse prognosis in patients with cirrhosis.Results: In Group A patients with portal hypertension, we observed lower levels of aspartate aminotransferase, laminin, serum hyaluronic acid, type III procollagen N-terminal peptide, total bile acids, and cholylglycine acid compared to Group B. On the other hand, levels of alanine aminotransferase, white blood cells, and serum albumin were higher in Group A than in Group B. These differences between the groups were statistically significant (P < 0.05). Multivariate analysis of the aforementioned risk factors indicated that low white blood cell count, high cholylglycine acid levels, and high serum hyaluronic acid levels were identified as independent risk factors for the occurrence of difficult-to-control complications in decompensated portal hypertension among patients with liver cirrhosis (P < 0.05).Conclusion: Liver cirrhosis patients with portal hypertension and multiple risk factors like low white blood cell count and high liver transaminase levels should be cautious regarding the progression of portal hypertension when combined with splenomegaly, liver fibrosis, and bile stasis, as it often indicates a poor prognosis.Keywords: portal hypertension, white blood cells, glycine cholate, serum hyaluronic acid