Purpose <p>Colorectal cancer liver metastases (CRLM) worsen the prognosis of patients. High-intensity focused ultrasound (HIFU) is a non-invasive treatment for CRLM, but reliable prognostic tools for HIFU patients are lacking. This study aimed to develop and validate a nomogram to predict the risk of 1-year all-cause mortality (ACM) in patients with CRLM receiving HIFU.</p> Methods <p>This retrospective cohort study enrolled patients with CRLM who received HIFU between January 2014 and December 2023 at two medical centers. Data from Chongqing Medical University’s Second Affiliated Hospital were used as the training set, while data from Suining Central Hospital were used as the external validation set. Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) regression to identify relevant predictors and establish a nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).</p> Results <p>Among 162 patients (121 in the training set, 41 in the validation set), the 1&#xa0;year ACM rates were 31.4% and 24.4%, respectively. LASSO regression identified six predictors: sex, number of liver metastases, extrahepatic metastases status, number of extrahepatic organs involved, alkaline phosphatase level (ALP), and albumin level (ALB). The nomogram demonstrated robust performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.816–0.956) in the training set and 0.706 (95% CI: 0.495–0.918) in the validation set. Calibration curves showed good agreement, and DCA confirmed its clinical utility.</p> Conclusion <p>A nomogram was developed and externally validated, which provides clinicians with an accurate and reliable tool for individualized prognostic assessment and treatment optimization in patients with CRLM undergoing HIFU.</p>