Background: Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and the second leading cause of cancer-related deaths worldwide. Egypt is one of the African countries with a high incidence of HCC. The process of carcinogenesis in the liver, particularly in post-hepatitic necrosis, is related to the severity of liver damage and fibrosis. The present study aimed to investigate the utility of King’ s score to identify patients at higher risk of developing HCC among patients with hepatitis C virus-related cirrhosis. Method: 58 patients were included in this retrospective case-control study. They were divided into two groups; group I included 29 patients diagnosed with HCC and group II comprised 29 patients without HCC. King’ s score was calculated for all the patients based on their pararmeters at the time of diagnosis and their records of one year prior to the diagnosis. Results: King’ s score was significantly higher in group I, not only at the time of diagnosis (95. 4± 45. 2 vs. 24. 23± 7. 4, P<0. 001), but also when calculated from the patients’ records a year before the diagnosis (70. 4± 41. 8 vs. 17. 46± 8. 2, P<0. 001). Conclusion: King’ s score can diagnose higher risk of developing HCC up to one year before the appearance of focal lesion.