Risk factors for the development of cirrhosis within 1-year in non-cirrhotic patients with HBV- related acute-on-chronic liver failure.

Aims and Background: This study aimed to provide a preliminary clarification of the predictive factors for the development of cirrhosis within 1-year cirrhosis in non-cirrhotic HBV-associated acute-on-chronic liver failure (HBV-ACLF) patients and develop a risk stratification algorithm. Methods: Non-cirrhotic HBV-ACLF patients who survived for at least 1 year and had complete clinical records were included from January 2016 to December 2023 at Beijing Youan Hospital, Capital Medical University. Multivariate logistic regression was performed to identify independent predictors of cirrhosis progression. Results: Of the 329 HBV-ACLF patients initially screened, 109 were enrolled in the study, and a 1-year follow-up revealed that 21.1% of the non-cirrhotic patients developed cirrhosis. Multivariate logistic regression identified independent predictors of cirrhosis progression: non-resolution of total bilirubin (TB) levels within 28 days [5.64 (1.39-25.00)], failure to normalize the international normalized ratio (INR) within 28 days [6.34 (1.52-29.50)], and baseline platelet (PLT) count [0.98 (0.97-0.99)]. ROC analysis demonstrated strong predictive accuracy for cirrhosis with INR normalization (AUC = 0.82), TB resolution (AUC = 0.78), and baseline PLT count (AUC = 0.75). A risk stratification pathway incorporating INR normalization and baseline PLT effectively categorized patients into low, medium, and high-risk groups, with corresponding cirrhosis incidence rates of 5.4%, 29.4%, and 77.8%, respectively. Conclusion: The findings underscore the importance of INR normalization, TB resolution, and baseline PLT count as independent predictors of cirrhosis and provide a useful framework for clinical decision-making and early intervention.