Background: Systemic inflammatory response syndrome is relatively common in patients with complicated cirrhosis. Red cell distribution width (RDW), is known to be an inflammatory response marker which is easily evaluated from blood samples. Aim of Study: The aim of this study was to evaluate the role of RDW in the prediction of liver decompensation in a previ-ously compensated liver cirrhosis. Patients and Methods: This study was conducted as a ret-rospective study, which included 401 patients with established diagnosis of liver cirrhosis. The patients were divided into 2 groups; compensated control group which included 100 pa-tients with compensated liver cirrhosis and 301 patients with newly decompensated cirrhosis those patients were subdivided, according to the form of hepatic decompensation, into 3 groups; first hepatic encephalopathy group included 136 patients, first hematemesis group (84 patients) and newly developed ascites group which included (81 patients). Medical records of the pa-tients were retrospectively reviewed for medical history, clini-cal and laboratory characteristics on admission. Results: RDW was significantly high in hepatic decom-pensated group as compared with compensated control group (t-test=18.398), (p-value=0.001). The frequency of developing decompensation was statistically significant higher among pa-tients who had high RDW (96.9%) than those who had normal RDW (36.6%) (p-value=0.001). RDW at a cutoff point ≥13.55, the sensitivity and specificity for prediction of hepatic decom-pensation were 86.4% and 85% respectively with area under the curve (AUC)=0.944, confidence interval (CI): 0.924-0.964) (p-value=0.001). Conclusion: RDW may serve as a potential predictor of liv-er decompensation and therefore a prognostic indicator forcom-pensated liver disease.