Objective To investigate the prognostic value of risk factors in hepatitis B patients with acute-on-chronic liver failure (ACLF) .Methods A total of 263 patients with hepatitis B-ACLF were enrolled in the study.The baseline levels of albumin (Alb) , cholinesterase (CHE) , and total cholesterol (TC) were measured, any complications were recorded, and the MELD score was calculated.All of the patients were followed-up for one year.The prognostic value of known risk factors was analyzed by the multivariate Cox proportional hazard model.Results Sixty-seven patients died within the 1-year follow-up period, yielding a mortality rate of 25.5%.The baseline levels of Alb, CHE, and TC were all significantly lower in the patients who ultimately died than in those who survived.The serum TC level was found to be inversely correlated with increases in the MELD score.Hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, TC≤2.5 mmol/L, and MELD score≥30 were identified as independent prognostic factors for hepatitis B-ACLF.Conclusion Several risk factors of hepatitis B-ACLF are prognostic factors of disease outcome, namely death within one year, including hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, TC≤2.5 mmol/L, and MELD≥30.