Objective: Patients with chronic hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) who do not have underlying cirrhosis are at a high risk of progressing to cirrhosis within one year during the recovery period. However, the specific risk factors contributing to this progression remain poorly understood. This study aims to identify the factors influencing cirrhosis development and to establish a pathway for risk stratification. Methods: Clinical data were collected from non-cirrhotic HBV-ACLF patients who survived beyond one year and had comprehensive clinical records. Independent factors associated with the progression to cirrhosis were identified, enabling the development of a risk stratification pathway. Results: A prospective one-year follow-up of 109 non-cirrhotic patients with HBV-ACLF showed that 21.1% (n=23) developed cirrhosis. An assessment of clinical features, laboratory metrics, and the fluctuating patterns in liver function identified several independent factors for the development of cirrhosis: unresolved total bilirubin (TB) levels [5.64 (1.39-25.00)], failure to normalize the International Normalized Ratio (INR) [6.34 (1.52-29.50)], and baseline platelet (PLT) count [0.98 (0.97-0.99)]. Receiver operating characteristic (ROC) analysis demonstrated that INR normalization (AUC=0.82), TB resolution (AUC=0.78), and the baseline PLT count (AUC=0.75) had strong predictive accuracy for cirrhosis. A risk stratification model incorporating INR normalization and baseline PLT effectively classified patients into low-risk, medium-risk, and high-risk groups, with incidence rates of cirrhosis at 5.4%, 29.4%, and 77.8%, respectively. Conclusion: This study emphasized the crucial role of INR normalization, TB resolution, and the baseline PLT count in predicting the risk of cirrhosis development within one year in non-cirrhotic HBV-ACLF patients. By integrating INR normalization with baseline PLT, a risk stratification model for cirrhosis development was established, which provides targeted intervention guidance for clinicians and serves as a practical clinical tool for the development of personalized treatment plans.