Objective: The co-existence of fatty liver and chronic hepatitis B (CHB) is common among patients.The study was aimd to explore the prognosis of CHB patients complicated with fatty liver. Methods: A retrospective study of 915 patients with CHB treated in the department of infectious disease of Jiangsu Province Hospital between 2016 and 2017 was conducted. Liver steatosis assessment was performed using Fibroscan. A median controlled attenuation parameter (CAP) score of 222 or more dB/m was considered to have liver steatosis. Patients were divided into two groups according to the CAP value: CHB with fatty liver and simple CHB. HBV DNA viral load and the degree of liver fibrosis were compared among the two groups. Results: Among the 915 CHB patients, 447 of whom were diagnosed with hepatic steatosis (48.8%). CAP value was negatively correlated with HBV DNA level. Compared with the simple CHB patients, CHB with fatty liver had a lower degree of liver fibrosis (OR=0.79, 95%CI 0.67-0.92, P=0.003). CAP values were U-shaped correlated with Alanine transaminase (ALT). Conclusion: In this study, we found that the severity of liver inflammation was aggravated in patients with severe fatty liver.