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Objectives: 2019-nCoV has become a global threat to human health. The primary objective of this study was to examine the hepatic damage in 2019-nCoV infected patients and the associated underlying causes. Methods: In this retrospective study, a total of 68 laboratory-confirmed and 20 suspected COVID-19 cases from 23rd January 2020 to 15th February 2020 were included. The study was conducted in The First People’s Hospital of Jingzhou, Hubei. SPSS version 23.0. was used for Statistical analysis using the Student’s t-test or Chi-square test. Data was analyzed for the clinical characteristics and underlying causes of liver damage. The outcomes were followed up until March 29, 2020. Results: Out of the 68 COVID-19 confirmed cases, 51 had an abnormal liver function, of which 15 had an abnormal liver function at the time of hospital admission. The relationship between the liver function and clinical prognosis of patients showed that the abnormal liver function was positively correlated with the severity of the infection (100% vs.70.2%, p=0.036). The proportion of patients with an elevated level of ALT and a depleted level of Albumin (ALB) were significantly lower in the COVID-19 suspected group than the confirmed group (5% vs. 50.9%, p=0.000; 10% vs. 35.8%, p=0.030, respectively). Besides, the utilization rate of lopinavir/ritonavir, azithromycin, and methylprednisolone in COVID-19 suspected patients were significantly lower than the confirmed patients (25% vs. 62.3%, p=0.004; 35% vs. 62.3%, p=0.037; 25% vs. 64.2%, p=0.003, respectively). Conclusions: Liver function anomalies are one of the common symptoms associated with the COVID-19 infection, where virus-replication in the liver cells, virus-induced inflammatory response, and administration of clinical medication could be the plausible reason. doi: https://doi.org/10.12669/pjms.37.5.4161 How to cite this:Zuo G, Liu W. The clinical characteristics and underlying causes of liver damage in patients with COVID-19 infection: Retrospective analysis. Pak J Med Sci. 2021;37(5):1282-1287. doi: https://doi.org/10.12669/pjms.37.5.4161 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.