Background: Hepatic failure is a commonly observed form of organ failure in people who are seriously ill. Liver damage and subsequent failure contribute significantly to a substantial rise in both mortality  and morbidity rates. The aim of the work was To ascertain the risk factors, frequency, and prognosis of primary hepatic dysfunction in critically sick children hospitalized to the Pediatric Intensive Care Unit (PICU). Subjects & methods; this single-center cross sectional  research  was done at the PICU of Beni-Suef University Hospital. The study involved all cases admitted to the PICU from January to December 2022. Those were 400 patients admitted to PICU and 23 patients of them were  primary hepatic dysfunction. Result: we observed significant associations between various health complications and hepatic dysfunction in patients, Only 5.7% of hospitalizations were attributed to primary hepatic dysfunction, and those with hypoxia were significantly more likely to experience hepatic dysfunction, where Hypoxia occurred in 11 (47.8%) of them and blood product transfusion in 11 (47.8%), which means that they are significant risk factors for primary hepatic dysfunction. Mechanical ventilation occurred in 3 (13 %) of primary hepatic patients, and Sepsis in 5 (21.7%), Heart failure happened in 5 (21.7) %), Shock in 6 (26.1%) in primary hepatic patients. There are no patients with cardiac arrest in primary hepatic dysfunction and there are no patients who had surgery or abdominal surgery. So, they weren't risking factor of primary hepatic dysfunction. They had a high mortality rate at 73.9%.  Conclusion: Hepatic dysfunction is a frequent finding in PICU. Consideration should be given to even a slight LFT rise in PICU.  Primary hepatic dysfunction patients admitted to PICU have a significant death rate. The prevalence of primary hepatic dysfunction is strongly correlated with hypoxia, sepsis, cardiovascular events, and mechanical ventilation. Hepatic impairment is a significant predictor of PICU mortality and LOS.