Background:Cirrhosis represents the terminal stage of chronic liver disease, characterized by progressive hepatic dysfunction and systemic metabolic derangements, including disruptions in iron metabolism. This study investigates the relationship between iron metabolism markers and the severity of cirrhosis among patients in a tertiary care setting in Northeast India. Methods:A prospective cross-sectional study was conducted from March to August 2024, involving 112 cirrhotic patients from Tripura Medical College. The severity of cirrhosis was classified using the Child-Pugh scoring system. Serum iron, ferritin, total iron-binding capacity (TIBC), and haemoglobin levels were analyzed. Statistical comparisons were made using ANOVA. Results:The study cohort (mean age 51.1 ± 7.3 years) exhibited a male predominance (83%). Cirrhosis severity was categorized as Class A (28.6%), Class B (40.2%), and Class C (31.3%). Significant alterations in iron metabolism markers were observed with increasing disease severity. Serum iron and ferritin levels increased progressively (p < 0.001), while haemoglobin and TIBC levels declined (p < 0.001). Conclusion:Progressive cirrhosis severity is associated with significant dysregulation of iron metabolism. These findings highlight the potential utility of monitoring iron markers to assess disease progression and guide clinical management. Further research is needed to elucidate the underlying mechanisms and explore therapeutic implications.