Objective The liver is one of the main target organs of paraquat poisoning,while there are little clinical researches studying the toxic hepatitis of paraquat poisoning.This retrospective research studied the demographic data,clinical features,and outcome after paraquat poisoning,and evaluated the risk factors of toxic hepatitis after paraquat intoxication.Methods We retrospective studied the clinical data of paraquat poisoning patients in recently five years.Patients were categorized into toxic hepatitis group and non-toxic hepatitis group according to their serum ALT level.Demographic,bio-chemical and artery blood gas analysis data were obtained for analysis.Mortality rates and risk factors of toxic hepatitis were also analyzed.Results A total of 320 patients with acute paraquat poisoning were included in this study,among these,134 patients(41.9%)had toxic hepatitis within 3.6±1.3 days after exposure to paraquat with ALT 413(IQR,227.8~614.3)U/L.The toxic hepatitis group had more ingestion amount of paraquat(p<0.0001),higher plasma paraquat concentration(p<0.0001),and longer time from ingestion to ED(p=0.015).The toxic hepatitis group also suffered from greater incidences of acute kidney failure(p<0.0001)and hypoxemia(p<0.0001)and acute pancreas injury(p<0.0001)than patients without hepatitis.The overall mortality rate was 43.8%(140/320),and the mortality rate in toxic hepatitis group was higher than non-toxic hepatitis group(p<0.0001),Kaplan-Meier analysis also revealed a significant higher mortality rate in toxic hepatitis group(p<0.0001,log-rank test).A multivariate Cox regression analysis revealed that the toxic hepatitis was correlated with increased hazard ratios(HR)for all-cause mortality(HR=1.921,95%CI 1.011~3.649,p=0.046).Conclusion Toxic hepatitis was a common complication of paraquat poisoning,and also was a risk factor of all-cause mortality rate.Toxic hepatitis generally appeared within a week,and the spectrum of hepatitis seemed more seriously.