[Predictive value of liver-to-spleen volume ratio for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure].

<b>Objective:</b> To investigate the predictive value of liver-to-spleen volume ratio (LSR) for short-term prognosis in patients with hepatitis B virus -related acute-on-chronic liver failure (HBV-ACLF). <b>Methods:</b> This retrospective study enrolled 168 HBV-ACLF patients diagnosed at Nantong Third People's Hospital between September 2019 and August 2023. Participants were stratified into survival (<i>n</i>=106) and non-survival (<i>n</i>=62) groups based on 90-day outcomes. Baseline clinical parameters and laboratory findings were recorded; and abdominal CT measurements were collected to calculate LSR. Comparative analysis of clinical characteristics was performed between groups. Cox proportional hazards regression analyses identified clinical predictors. Restricted cubic spline (RCS) modeling explored the dose-response relationship between baseline LSR and mortality risk. Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were employed to compare the prognostic performance of LSR with established scoring systems: Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failure Ⅱ score (COSSH-ACLF Ⅱ), model for end-stage liver disease (MELD), MELD combined with serum sodium (MELD-Na). Using the Delong test to compare differences in the areas under different curves (AUC). <b>Results:</b> A total of 168 patients were included, with an average age of (55.0±14.1) years, of which 110 were male. Among them, the survival group consisted of 106 cases, with an average age of (53.7±13.8) years and 70 males; the death group included 62 cases, with an average age of (57.4±14.4) years and 40 males.The survival group had higher results compared to the death group in LSR [<i>M</i>(<i>Q</i>₁, <i>Q</i>₃)] [3.1 (2.3, 4.5) vs 1.2 (1.0, 1.5)], liver volume [1 164.3 (1 002.1, 1 383.4) vs 713.9 (653.6, 884.2) cm³], and platelet count [109.0 (62.0, 147.8)×10⁹/L vs 78.0 (53.3, 133.3)×10⁹/L] (all <i>P</i><0.05). The survival group demonstrated lower values in the proportion of hepatic encephalopathy, international standardized ratio, lactate, total bilirubin, COSSH-ACLF Ⅱ score, MELD and MELD-Na scores (all <i>P</i><0.05). The results of the Cox proportional hazards regression modeling analysis demonstrated that hepatic encephalopathy (<i>HR</i>=2.01, 95%CI:1.11-3.63) and LSR (<i>HR</i>=0.17, 95%<i>CI</i>:0.10-0.30) as influencing factors of the death of patients with HBV-ACLF. RCS revealed a nonlinear association between baseline LSR and mortality risk (<i>P</i>_all<0.001, <i>P</i>_nonlinear=0.019). ROC analysis demonstrated the AUC of LSR [0.883 (95%<i>CI</i>:0.82-0.94)] was superior to COSSH-ACLF Ⅱ scores[0.77 (95%<i>CI</i>: 0.69-0.84)], MELD [0.68 (95%<i>CI</i>: 0.60-0.76)], and MELD-Na scores [0.64 (95%<i>CI</i>: 0.55-0.72)] (all <i>P</i><0.05). Calibration curves and DCA confirmed LSR's clinical utility in predicting the short-term prognosis in HBV-ACLF patients. <b>Conclusion:</b> LSR shows significant predictive value for short-term prognosis in HBV-ACLF patients.