Assessment of Thrombomodulin Level in Plasma of Patients with Compensated and Decompensated Liver Cirrhosis Background: In liver cirrhosis (LC), broad hepatocyte necrosis, and diffuse hyperplastic connective tissue causing distortion, obliteration & narrowing of blood vessels by regenerating nodules, promoting damage of endothelial cell. Thrombomodulin (TM) expression in hepatic endothelial cells is highly affected in liver diseases like viral hepatitis and liver damage causing soluble thrombomodulin (sTM) release. This study aimed to determine sTM level in LC patients and to study the association between sTM levels and severity of hepatic dysfunction. Methods: A case-control study was performed in GIT unit of Internal Medicine Department, Zagazig University Hospitals from October 2023 to March 2024. Ninety subjects were included, divided in 3 groups (A, B & C), 30 subjects in each group; Group A: Normal (as control). Group B: Compensated cirrhotic patients. Group C: Decompensated cirrhotic patients. All patients subjected to detailed history taking, clinical examination, radiological assessment, laboratory investigations and plasma sTM assessment. Results: A statistically significant increment in plasma sTM level in decompensated cirrhotic group C (1231.4±513) compared to control group A and compensated group B (420.2±102) (561.1±198) respectively (p<0.05). A significant association of plasma sTM with (ALT, AST, ALB, BIL, INR, platelets, & Child Score) in group B & C patients (p<0.05). TM with Cut-off 500.11 pg/dl can discriminate patients of three groups with AUC 0.654, sensitivity 92.5%, specificity 95%, PPV 94.4% and NPV 92.6%. Conclusions: The sTM level could have a role in early prediction of decompensated liver cirrhosis.