Abstract: Objective To observe the clinical characteristics and short-term survival of patients with splenomegaly and
acute-on-chronic liver failure related to chronic HBV infection. Methods Electronic medical records of patients with
acute-on-chronic liver failure were collected to analyze the clinical parameters and 4-week survival of patients with or without
splenomegaly. Results Of the 149 patients enrolled, the overall 28-day mortality rate was 48.3%, which was lower in patients
with enlarged spleen than those without (34.2% vs 54.1%, P=0.034). Compared with patients without splenomegaly, patients
with splenomegaly had lower platelet counts (P=0.001), lower ALT levels (P=0.005) and lower PT-INR (P=0.010). Although the
occurrence of hepatic encephalopathy was comparable between patients with or without splenomegaly, severe conditions were
more frequent in those without splenomegaly. Hepatic encephalopathy grades, serum creatinine levels, neutrophil percentages
over 70%, PT-INR and splenomegaly were independent factors associated with the 28-day survival, and this novel model was
superior to model of end-stage of liver disease in predicting the 4-week survival (P=0.017). Conclusion Patients with
splenomegaly that evolves into acute-on-chronic liver failure have unique clinical characteristics and further clinical
observations are warranted.