Objective To study the clinical characteristics of elderly patients with liver failure. Methods The clinical data of 623 elderly patients with liver failure from Jan. 2003 to Dec. 2013 in 302 Hospital of Chinese PLA were collected, and other 3791 young adult patients with liver failure during the same period were also collected as control group. The etiology and prognosis of elderly patients with liver failure were analyzed retrospectively. Results Elderly patients with liver failure accounted for 13.21% of the total number of liver failure patients in 2003, and 16.01% in 2013. The most frequent causes leading to liver failure were, in order of frequency, hepatitis B(68.06%), unknown causes (7.22%), hepatitis C (5.30%), hepatitis E (4.98%) and drug (4.65%). Acute or chronic liver failure (85.23% vs 90.56%) was the main type in the two groups. HEV infection-induced liver failure in elderly patients was the predominant cause of acute and subacute liver failure, accounting for 33.33% and 33.80% respectively in acute and subacute liver failure patients, which were significantly higher than that in the young adult group (7.77% and 12.94% respectively, P