{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:20:28Z","timestamp":1773984028329,"version":"3.50.1"},"reference-count":44,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program","doi-asserted-by":"publisher","award":["2022YFC2304500"],"award-info":[{"award-number":["2022YFC2304500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270631"],"award-info":[{"award-number":["82270631"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ECCM Program of the Clinical Research Center of Shandong University","award":["2021SDUCRCB006"],"award-info":[{"award-number":["2021SDUCRCB006"]}]},{"name":"Young Taishan Scholars","award":["tsqn202103169"],"award-info":[{"award-number":["tsqn202103169"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Individuals who do not match any specific immune stage of chronic hepatitis B are classified into the gray zone, and appropriate management for these patients remains unclear. This study aimed to develop and validate a noninvasive model to identify gray zone patients requiring antiviral therapy (AVT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively collected data on 200 gray zone patients not requiring AVT, according to assessment by noninvasive parameters from 2010 to 2023 in 6 hospitals, and randomized them into development (n = 140) and validation (n = 60) cohorts. Univariable and multivariable regression analyses were performed to identify independent variables for establishing a nomogram to predict the probability of requiring AVT by liver biopsy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Seventy-eight patients (n = 39%) were identified as requiring AVT. The following were identified as independent variables for constructing the nomogram: age (odds ratio [OR], 1.06; 95% CI, 1.01\u20131.11), alanine aminotransferase (OR, 2.43; 95% CI, 1.08\u20135.59), lymphocyte percentage (OR, 6.43; 95% CI, 1.23\u201333.64), platelet count (OR, 0.99; 95% CI, .98\u20131.00), and international normalized ratio (per 0.01) (OR, 0.99; 95% CI, .98\u2013.1.00). These variables showed good discriminability based on the development data set (area under the curve, 0.755) and validation data set (area under the curve, 0.707), calibration, and clinical applicability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Gray zone patients requiring AVT should be identified, and the model developed here is a promising tool.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trials registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov NCT06041022.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf070","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T14:02:31Z","timestamp":1739800951000},"source":"Crossref","is-referenced-by-count":2,"title":["A Model to Identify Gray Zone Patients With Chronic Hepatitis B Requiring Antiviral Therapy: A Multicenter Retrospective Study"],"prefix":"10.1093","author":[{"given":"Xue-Yan","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Hepatology, Qilu Hospital of Shandong University"},{"name":"Institute of Hepatology, Shandong University , Jinan"},{"name":"Department of Hepatology, The First Hospital of Lanzhou University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi-Dong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Linyi People's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7607-1226","authenticated-orcid":false,"given":"Bai-Yun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Qilu Hospital of Shandong University"},{"name":"Institute of Hepatology, Shandong University , Jinan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7401-2168","authenticated-orcid":false,"given":"Qiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Bao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-2631","authenticated-orcid":false,"given":"Ming-Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical 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Qingdao University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Yu","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling-Yun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Xi\u2019an Jiaotong University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Xin","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Qilu Hospital of Shandong University"},{"name":"Institute of Hepatology, Shandong University , Jinan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"An","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Qilu Hospital of Shandong University"},{"name":"Institute of Hepatology, Shandong University , Jinan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-4443","authenticated-orcid":false,"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Cheeloo College of Medicine"},{"name":"Institute for Medical Dataology, Shandong University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Li","family":"He","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Xi\u2019an Jiaotong University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Shi","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9126-679X","authenticated-orcid":false,"given":"Yu-Chen","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Qilu Hospital of Shandong University"},{"name":"Institute of Hepatology, Shandong University , Jinan"},{"name":"Department of Immunology, School of Basic Medical Science, Cheeloo College of Medicine, Shandong University , Jinan 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