Abstract: OBJECTIVE To investigate the influencing factors of septic shock in patients with liver failure. METHODS Totally 50 patients with liver failure complicated with septic shock at the Third People’s Hospital of Haikou City of Hainan Province from Jan. 2018 to Dec. 2019 were selected as the septic shock group, and 50 patients with liver failure who did not develop septic shock at the same period according to the principle that the age difference does not exceed 2 years were selected as non-infectious shock group. The patient's age, sex, medical history, serum immunoglobulin M（IgM）, C-reactive protein（CRP）, alpha fetoprotein（AFP）, blood lactate（Blood lactate, LAC）, Urea nitrogen（BUN）, short-term Creatinine（Cr） data were collected, the infectious factors of septic shock in patients with liver failure were summarized, and pathogens and their drug resistance were analyzed. RESULTS The Cr and lAC in septic shock group were（323.45±123.32） μg/L and（5.48±0.69） mmol/L respectively, significently higher than those in non-infectious septic shock group. IgG, IgA and IgM were（26.12±4.36） mg/L,（12.23±1.23） mg/L and（13.25±2.39） mg/L, respectively, significently lower than those in non-infectious septic shock group（P＜0.05）. Cr, IgG and IgM were the influencing factors of septic shock in patients with liver failure（P＜0.05）. A total of 102 strains of pathogens were detected in 50 infected patients, of which 61 strains of Gram-negative bacteria accounted for 59.80%, mainly Escherichia coli; 25 strains of Gram-positive bacteria accounted for 24.51%, and 16 strains of fungi accounted for 15.69%. The drug resistance of Escherichia coli to ampicillin, tetracycline, levofloxacin, cefazolin, ceftazidime, ceftriaxone, ciprofloxacin were more than 50%, while Escherichia coli were sensitive to nitrofurantoin, ertapenem and imipenem. Klebsiella pneumoniae was highly resistant to drugs such as ampicillin, cefazolin and ceftazidime, and 0% to ertapenem. The resistance of Staphylococcus aureus to ampicillin was 90.91%, and it was sensitive to nitrofurantoin and imipenem. The resistance of Enterococcus faecium to ampicillin and levofloxacin was 100.00%. Candida albicans was sensitive to amphotericin B, fluconazole and carbamazepine. The resistance of Aspergillus to fluconazole and ketoconazole was 100.00% and 50.00%, respectively. CONCLUSION Patients with liver failure were affected by the impaired immune function of the liver, and the probability of bacterial infection increased, which was easy to cause metabolic disorders, such as abnormal indexes such as blood lactic acid and creatinine, ultimately put the patients at risk of septic shock. Multivariate analysis showed that Cr, IgG and IgM were the influencing factors of septic shock in patients with liver failure. The main pathogens of infection are Escherichia coli. Due to the use of commonly used antibiotics, the pathogens were resistant to a variety of drugs, suggesting that the clinical use of antibacterial drugs should be standardized and rational.