Among 605 patients undergoing laparoscopic cholecystectomy at a Qinghai hospital situated at 2,260 meters elevation, systolic blood pressure emerged as the only statistically significant positive predictor of cholecystitis (OR=1.027 per mmHg, 95% CI: 1.008–1.047, P=0.005). Counterintuitively, neither BMI overweight nor obesity reached significance, nor did sex—variables that dominate cholecystitis risk models in lowland populations. A notable 'age paradox' appeared: younger patients (<30 years) showed higher cholecystitis rates (36.8%) than older patients (≥60 years, 25.0%), with age inversely associated overall (OR=0.978/year). Adding blood pressure to the classical age-BMI-sex model improved AUC from 0.575 to 0.615.
This preprint—not yet peer-reviewed—challenges a longstanding assumption that the well-known female-sex and obesity risk factors for gallstone complications translate uniformly across environments. High-altitude chronic hypoxia is known to alter autonomic tone, erythropoiesis, and vascular remodeling, plausibly linking elevated systolic pressure to gallbladder wall ischemia or altered bile dynamics. However, the modest AUC improvement (+0.040) signals only marginal predictive gain, and the single-center retrospective design with 605 patients limits generalizability. Selection bias in surgical candidates is a real concern, likely explaining the paradoxical younger-patient finding. The study's own authors acknowledge their original hypothesis was falsified—a commendable display of transparency. If replicated in multicenter high-altitude cohorts, blood pressure screening could meaningfully refine cholecystitis risk stratification for plateau-dwelling populations across Tibet, the Andes, and similar regions.