Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients Background: Cirrhotic patients have variable degrees of hepatic dysfunction. Impaired portal he-modynamics and hyponatremia occurs in the setting of end-stage liver disease. Aim: to uncover the role of portal hemodynamics in mortality and adverse outcome prediction of hyponatremic cirrhotic patients. Subjects and Methods: Eighty cirrhotic patients with hyponatremia (serum Na<130mmol/L) were included. diagnosis of hepatic encephalopathy using West Haven criteria, la-boratory investigations, modified Child-Pugh and MELD scores were calculated, abdominal ultraso- nography with Doppler study of portal circulation and upper GIT endoscopy were performed and the patients were followed up during their stay in hospital. Results: Serum sodium level has high statistically significant negative correlation with modified Child-Pugh score (P <0.001) and with MELD score (P <0.001). Most of the patients developed hepatic encephalopathy, spontaneous bac- terial peritonitis, hepato-renal syndrome, and bleeding recorded in some patients; meanwhile mor- tality in 10% of the patients. In addition, apart from Hepatic Artery resistive Index, the difference in MELD score, MELD-Na score and Portal vein congestive Index between non-survived and survived patients was statistically insignificant, although all these indices were highly significant with hepat- ic encephalopathy, Portal vein congestive Index is highly significant in hepato-renal syndrome and bleeding esophageal varices, and Hepatic Artery resistive Index is highly significant in hepato-renal syndrome. Analysis of the receiver operating characteristic curve revealed that Portal vein CI was the most sensitive indicator (sensitivity 78.5%) and hepatic A resistive Index was the most specific indicator for prediction of mortality in hyponatremia cirrhotic patients. Conclusion: Portal vein CI and hepatic A. RI can be used in the prediction of mortality in hyponatremia cirrhotic patients.