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A retrospective nine\u2010center cohort study along with an independent validation cohort is conducted to examine the efficacy of azvudine (Clinical Trial Registration Number: NCT06349655). The primary outcome is all\u2010cause mortality and the secondary outcome is composite disease progression. Efficacy is assessed via Kaplan\u2013Meier analysis and Cox regression, with subgroup and sensitivity analyses for further validation. Among 32\u00a0864 hospitalized SARS\u2010CoV\u20102 infected patients, 1022 eligible azvudine recipients, and 1022 controls are included through propensity score match. Kaplan\u2013Meier analysis reveals that azvudine treatment is associated with a lower risk of all\u2010cause mortality and composite disease progression (both <jats:italic>p<\/jats:italic>&lt;0.0001). Cox regression analysis suggests azvudine recipients could have a 39% lower risk of all\u2010cause mortality than controls (95% confidence interval [CI]: 0.468\u20130.795, <jats:italic>p<\/jats:italic>&lt;0.001), but with no notable significance in composite disease progression (hazard ratio: 0.85, 95% CI: 0.686\u20101.061, <jats:italic>p<\/jats:italic> = 0.154). Subgroup analysis suggests that azvudine has a greater benefit for both all\u2010cause mortality and composite disease progression in patients with kidney diseases or without autoimmune diseases. Three sensitivity analyses and validation cohorts confirm the robustness of the findings. Safety analysis observes few adverse events in azvudine recipients. Within 15 days after azvudine administration, no significant difference in liver function indexes and kidney function indexes is observed between the two groups except for a few time points. These findings demonstrate that azvudine shows potential clinical efficacy in improving all\u2010cause mortality in hospitalized SARS\u2010CoV\u20102 infected patients with liver diseases, with acceptable adverse effects.<\/jats:p>","DOI":"10.1002\/advs.202405679","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T06:51:21Z","timestamp":1740207081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Antiviral Efficacy and Safety of Azvudine in Hospitalized SARS\u2010CoV\u20102 Infected Patients with Liver Diseases Based on a Multicenter, Retrospective Cohort Study"],"prefix":"10.1002","volume":"12","author":[{"given":"Junyi","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases State Key Laboratory of Antiviral Drugs Pingyuan Laboratory The First Affiliated Hospital of Zhengzhou University  Zhengzhou 450052 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