To evaluate the clinical utility of serum levels of N- terminal pro C- type natriuretic peptide (NT-pro CNP) in patients with hepatitis C related chronic liver disease (CLD), in prospective to disease complications and progression. This study included 66 hepatitis C- related CLD patients with and without ascites and 15 healthy individuals (control group). Serum NT-pro CNP was measured by ELISA. A stepwise progressive increase in NT-pro CNP levels was recorded through controls, patients without ascites and patients with ascites (p< 0.05). In addition, patients with hematemesis or encephalopathy had more than its double values than those without (p<0.01). Moreover, a significant difference was observed in the marker levels among esophageal varcies stages 1, 2, 3 (H=13.679, p=0.001), with highest levels in grade 3. NT-pro CNP correlated positively with alpha fetoprotein (rs =0.455, p=0.008) with no significant correlation neither with MELD nor Child scores (p>0.05). ROC curve analysis revealed the overall performance of the marker in discriminating CLD patients collectively from controls, the optimum cut-off level was 85 ng/L (AUC= 0. 803, sensitivity 84.8%& specificity 53.3%). An increased level of NT-pro CNP is a promising non-invasive marker of hepatitis C related CLD complications and disease
progression.