Objective：To identify the risk factors for early mortality（≤30 days）in patients with ruptured naive hepatocellular carcinoma（HCC），including treatment modality. Methods：Between Jun 2012 and Dec 2016，the medical records of 80 ruptured naive HCC patients who received conservative treatment or transarterial embolization（TAE）as initial therapy from the authors’ affiliated hospital were retrospectively analyzed. According to the survival state within 30 days，the selected patients were divided into the survival group and the dead group. An independent sample t-test was used for the continuity variables between the two groups，and the constituent ratios and rates were tested using the χ2 test. The possible risk factors related to early mortality were analyzed by using univariate and multivariate logistic regression model（P < 0.05）. Results：Of 80 patients，the early mortality was 28.8%. Univariate analysis showed that the proportion of patients with shock on admission（P=0.008），conservative treatment（P < 0.001），poor Child-Pugh class（P < 0.001）and advanced modified tumor stage of the liver cancer study group of Japan（LCSGJ）（P < 0.001）in the dead group was significantly higher than those in the survival group，and the patients’ initial hemoglobin level of the dead group（P < 0.001）was also significantly lower than that of the survival group. Multivariate Logistic regression analysis indicated that patients with shock on admission（OR=5.543，P=0.026），poor Child-Pugh class［class B（OR=10.395，P=0.009）and class C（OR=23.633，P=0.006）］and conservative treatment（OR=8.576，P=0.002）were independent risk factors for early mortality. Conclusion：Among ruptured naive HCC patients，the early mortality is high. For such patients，actively correcting shock while improving liver function as early as possible should undoubtedly have great significance for improving the prognosis. Additionally，reasonably expanding the indications of interventional therapy is essential.