U‐Shaped Relationship Between CT‐Measured Liver‐To‐Spleen Volume Ratio and Mortality in HBV‐ACLF Patients

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a life-threatening condition with high short-term mortality, making early prognosis crucial. The liver-to-spleen volume ratio (LSVR) provides important prognostic information but is not included in current tools. This study evaluated the link between LSVR from computed tomography and short-term mortality in HBV-ACLF patients. The study included 278 patients, divided into five groups based on LSVR quintiles. The main outcome was 28-day mortality, with a secondary focus on 90-day mortality. Multivariable Cox regression and restricted cubic splines were used to analyse the LSVR-mortality relationship. Participants had a mean age of 48 years, 82.7% were male, with 28- and 90-day mortality rates of 23.4% and 31.3%, respectively. After adjusting for covariates, the risk of 28-day mortality was elevated by 553% (OR 6.53, 95% CI 1.86-23) in the highest quintile of LSVR (Q5 ≥ 3.6) and by 343% (OR 4.43, 95% CI 1.14-17.16) in the lowest quintile (Q1 ≤ 1.6), as compared to the reference quintile (Q3 2.4-2.9). The curve-fitting results showed a U-shaped relationship between LSVR and the risk of 28-day mortality and 90-day mortality, with an infection point of 2.7. There is a U-shaped relationship between LSVR and mortality in HBV-ACLF patients. Higher or lower LSVR is associated with an increased risk of short-term mortality in HBV-ACLF patients.