Background: Nutritional supplementation may affect the outcomes of liver cirrhosis. Zinc deficiency is common among patients with liver cirrhosis. Objectives: To reveal the impact of zinc replacement therapy in the severity, frequency, and outcomes of hepatic encephalopathy (HE) among a sample of Egyptian patients. Patients and Methods: Patients aged more than 18 years and had decompensated liver disease and developed HE regardless of its grade were included in the current study. Patients were categorized into three groups based on the serum level of zinc and whether patients received zinc replacement therapy or not. Results: An overall 90 patients with decompensated liver disease as a sequel of HCV were enrolled in the present investigation. Patients were furtherly assorted based on the presence of zinc deficiency and replacement therapy into three groups. The mean ages of the included patients were 52.3±4.7, 47.23±4.7, and 41.35±4.28 among groups 1, 2, and 3, respectively. Patients with zinc deficiency and received zinc replacement therapy experienced better outcomes in the terms of short ICU stay and total hospital stays, in contrast to patients within groups 2 and 3 .There was a statistically significant negative correlation between the levels of Zinc and the frequency of HE. Conclusion: Patients developed HE should receive a comprehensive treatment protocol including zinc replacement therapy even if they have normal zinc levels in order to ameliorate the catastrophic sequels of HE.