Abstract: Objective To explore the factors influencing the prognosis of elderly chronic severe hepatitis (CSH) .Methods Clinical data of 65 elderly CSH were analyzed retrospectively, cases were divided into alive group and dead group according to their prognosis, the important biochemistry parameters (ALT、TBil、PTA、ALB、TBA、Tch) , disease degree stage, complications and liver cirrhosis history of the two groups were compared.Results Simple HBV infection is main cause of elderly CSH, total bilirubin (TBil) was higher and prothombin active (PTA) , albumin (ALB) , serum total cholesterin (Tch) were lower in dead group than alive group (P<0.05, P<0.01) .There were no difference in alanine transaminase (ALT) and total bili acid (TBA) between the two groups (P>0.05) .There were significant difference in disease degree stage and liver cirrhosis history between the two groups (P<0.01) .All cases had no less than one kind complication, there were significant difference in abdominal effusion, infection, hepatic encephalopathy (HE) hepatorenal syndrome (HRS) and number of complication between the two groups (P<0.05, P<0.01) .However, there were no difference in gastrointestinal hemorrhage and disorder of electrolyte.Conclusion HBV infection is a main cause of elderly CSH, biochemistry parameters, blood coagulation function, disease degree stage, liver cirrhosis history and complications could influence survival rate of elderly CSH, the prognosis of elderly CSH had no relation to ALT and TBA.