Abstract: Objective The aim of this study was to investigate Chinese Group for the Study of Severe Hepatitis B-acute-on-chronic liver failureⅡ(COSSH-ACLF II) score in combination with liver-to-spleen volume ratio (LSR) in predicting prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 93 patients with HBV-ACLF were enrolled in our hospital between February 2022 and February 2025, and all were carefully managed with routine comprehensive medical treatment. The patients were followed-up for 90 days and the survival was recorded. The baseline data of patients at admission were collected, including blood, biochemical and coagulation function routine, and upper abdominal CT examination for LSR calculation. Multivariate Logistic regression analysis was used to analyze the related risk factors affecting the prognosis of patients with HBV-ACLF, and receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to analyze the efficacy of COSSH-ACLF II score and LSR in predicting prognosis of patients with HBV-ACLF. Results 45 patients (48.4%) in our series died of liver failure and 48 patients survived, with 90 d survival rate of 51.6%; COSSH-ACLFⅡ score in dead group was (8.2±0.7) points, significantly greater than (6.8±0.9) points in survival group (P<0.05), and LSR was (1.5±0.9), significantly lower than (3.0±1.2) in survival group (P<0.05); the age, total serum bilirubin, international normalized ratio, model for end-stage liver disease score in dead group were significantly older or higher than those in survival group (P<0.05); multivariate Logistic regression analysis revealed that COSSH-ACLFⅡ score (OR=3.200, 95% CI: 1.458-7.021) was an independent risk factor affecting the prognosis of patients with HBV-ACLF, while the LSR (OR=0.119, 95% CI: 0.027-0.520) was a protective factor (P<0.05); ROC analysis showed that the AUC of COSSH-ACLFⅡ score in combination with LSR was 0.940, with a sensitivity of 86.7% and a specificity of 77.1%, much superior to any parameter did alone (P<0.05). Conclusion Application of COSSH-ACLF II score and LSR is efficacious in predicting prognosis of patients with HBV-ACLF, which warrants further clinical investigation.

Key words: Acute-on-chronic liver failure, Chinese Group for the Study of Severe Hepatitis B-acute-on-chronic liver failureⅡscore, Liver-to-spleen volume ratio, Prognosis