Objective To investigate the effects of acute liver injury on the elderly patients with sepsis in intensive care unit (ICU) and analyze its risk factors. Methods A retrospective analysis was made on the clinical data of 123 elderly septic patients admitted to the Intensive Care Unit (ICU) of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from September 2019 to August 2022. According to the presence of acute liver injury, they were divided into observationer group (sepsis complicated with acute liver injury, n=53) and control group (sepsis without acute liver injury, n=70). SPSS statistics 25.0 was used for data analysis, and according to the type of data, t-test, Mann-Whitney U test orχ² test were used for comparison between groups. Binary logistic regression was used to analyze the risk factors of senile sepsis complicated with acute liver injury. Results Compared with control group, the observation group showed a significant increase in acute physiology and chronic health evaluation (APACHE) Ⅱ score, direct bilirubin, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), serum myoglobin (MB), prothrombin time, activated partial thrombin time, thrombin coagulation time, white blood cells, neutrophil percentage, and procalcitonin levels (P<0.05). The mortality in the observation group were significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that ALT, GGT, procalcitonin level and APACHE Ⅱ score were risk factors of sepsis complicated with acute liver injury,while C-reactive protein level was protective factor. Conclusion Transaminase, coagulation index, infection index,and in-hospital mortality in the elderly septic patients complicated with acute liver injury increase significantly. Increased ALT, GGT, procalcitonin and APACHE Ⅱ score are risk factors of elderly septic patients complicated with acute liver injury.