Objective：To explore the related risk factors and predictive value ofacute hydrogen sulfide（H₂S）poisoning combined withcentral nervous system（CNS）injury. Methods：Acute H₂S poisoning patients withmoderate to severe conditions who were treated in multiple hospitals from January 1，2018，to April 30，2023 were recruited. Based on whether CNS injury was present，the gender，age， laboratory test results，30- day mortality，and neurological function prognosis were analyzed to investigatethe relevant risk factors for acute H₂S poisoning combined withCNS injury. The receiver operating characteristic（ROC）curve was used to analyze the efficacy of Lactate（Lac）and neuron-specific enolase（NSE）in predicting acute H₂S poisoning combined with CNS injury. Results：Compared with the non-CNS injury group，the CNS group has higher H₂S exposure concentration，significantly decreased systolic blood pressure， median glascow score and oxygenation indexupon admission，and significantly increased heart rate. The CNS injury group had a significantly higher incidence of acute respiratory distress syndrome（ARDS）and myocardial injury after admission. The30-day mortality rate was 50%，and the number of patients with mRS score > 2 was significantly increased. In addition，the analysis found that the levels of Lac and NSE upon admission were significantly higher in the CNS group compared to the non-CNS injury group，and the differences were statistically significant. The ROC curve showed that the combination of Lac and NSE was more effective in predicting acute H₂S poisoning combined with CNS injurythan a single index，with an area under curve（AUC）of 0.948. Conclusion：Patients with acute H₂S poisoning combined with CNS injury have increased incidence of ARDS and myocardial damage，increased 30-day mortality rate，and poor neurological prognosis. In addition，the early elevation ofserum Lac and NSE levels has higher clinical value in evaluating acute H₂S poisoning combined with CNS injury.