（Objective） To investigate the use of virtual touch tissue quantification (VTQ) to detect liver shear wave velocity (LSWV) in acute hepatic failure caused by hepatitis B infection ( acute-on-chronic hepatitis) B liver failure, ACLF-HBV) clinical evaluation of patients'' condition assessment and prognosis. Methods 128 patients with ACLF-HBV were enrolled. Blood routine, coagulation and liver and kidney biochemistry were collected the next day. Ultrasound was performed on the same day. LSWV was performed at the same time. Ultrasound score, Child-Turcotte-Puge (CTP) score, and end-stage liver disease model were calculated. (model for end-stage liver disease, MELD) points. After 12 weeks of follow-up, LSWV was reviewed weekly, and the patients were divided into the improved group and the worsened group according to the clinical prognosis. Results The total success rate of LSWV was 93.75% (120/128). The LSWV was (1.89±0.26) m/s at the time of enrollment, and the LSWV in the worsening group was higher than that in the improved group [(2.12±0.31) m/s vs (1.57±0.28) m/s, P <0.05]. With LSWV 2.15m/s as the threshold for poor prognosis, the sensitivity was 74.8% and the specificity was 65.4%. The AUROC for the prognosis of patients with ACLF-HBV was 0.87, and the predictive power was higher than the CTP score (AUROC: 0.69, z = 2.2, P = 0.028) and MELD score (AUROC: 0.71, z = 2.3, P = 0.019). Conclusion The application of VTQ technique to detect LSWV has a high accuracy in evaluating the prognosis of patients with ACLF-HBV, and it has certain clinical predictive value for short-term prognosis. Patients with LSWV values above 2.15 m/s had a poor prognosis, and dynamic changes in LSWV were more potentially valuable for patient prognosis assessment.