Overview

• The study tracked 127 untreated immune-tolerant patients for up to 10 years to assess transition to the immune-active phase.
• An external cohort of 109 patients validated prediction models built from the primary study data.
• The cumulative HBsAg/HBV DNA ratio independently predicted progression, outperforming cumulative HBsAg and HBV DNA alone (AUC 0.85 vs 0.67 and 0.64).
• Risk followed a non-linear pattern with a threshold at 1.791, below which the likelihood of progression increased steeply.
• Patients aged 30 or older showed notably higher progression risk, supporting closer monitoring and earlier antiviral consideration.