Background:Hepatorenal syndrome (HRS) develops in advanced liver cirrhosis duringthe first year of the diagnosis by 18% and increases to reachup to 40% at five years with two weeks median survival intype I HRS and four to six months intype II. Aim of the work:Frequency of HRS inpatients admitted to medical intensive care unit (ICU) ofZagazig University withadvanced cirrhotic,impact ofcirrhosis complications on the development of HRS, and itsclinical outcome. Patients and Methods:A cohort study on50patientswith the criteria of HRS in a period of six months and they were classified into type I and type II; withFull history, thorough clinical examination, routine investigations, APACHE II scorecalculationat admission, and mortality were followed at 2 weeks and 6 months.Results:Frequency of HRS was 9.4%mainly in type II.Spontaneous bacterial peritonitis (SBP) was higher in type I (p =0.03)with2.71 fold increase in relative risk.APACHEII score washigher in type I (p =0.02) with highermortality at 2 weeks (p =0.001). Conclusion:HRS type II was more common while type I had a more aggressive course.Morbidity and mortality increased significantly withSBP, HE and hematemesis, rapid and proper treatment especiallyfor SBP with early diagnosis and treatment of HRS, may improve the survival rate ofdiuretic resistant stage patients