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Background: Systemic inflammatory response syndrome (SIRS) and model for end-stage liver disease (MELD) predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis. Aim: This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization. Patients and methods: In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males). The role of Child-Pugh-Turcotte (CPT) score, MELD score, and SIRS on mortality was determined by the Kaplan-Meier method, and the prognosis factors were assessed with Cox regression model. Results: At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2%) patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI): 2.2-4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, p=0.03) and in case of patients with MELD score =16 (log-rank test=7.26, p=0.01) compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR)=3.02, [95% CI: 1.4-7.4], p=0.01) and MELD score >16 (HR=2.2, [95% CI: 1.1-4.3], p=0.02) were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study. Patients with MELD score >16 experienced hepatorenal syndrome (p=0.002) and encephalopathy (p=0.001) more frequently than that of patients with MELD score =16. SIRS was not useful in predicting complications. Conclusion: MELD score and SIRS can be used as tools for the prediction of mortality in black African patients with decompensated cirrhosis. [ABSTRACT FROM AUTHOR]