Background: Beyond the classic markers of liver failure, vitamin D deficiency has emerged as a silent driver of adverse outcomes in cirrhosis. By worsening survival prospects and daily functioning, it places an additional burden on patients. However, its prevalence, gender distribution, and impact on health-related quality of life (HRQoL) remain underexplored in South Asian populations. Materials and methods: We performed a cross-sectional analysis of 270 individuals with cirrhosis, confirmed by clinical and radiologic criteria, at a tertiary hospital in Faisalabad, Pakistan. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were determined, with deficiency defined as < 20 ng/mL. Disease stage was classified by the Child-Pugh score, and HRQoL was measured using the SF-8 survey. Statistical evaluation included Chi-square, ANOVA, and multivariable linear regression. Results: Overall, 57.8% of participants were vitamin D deficient. The frequency rose with advancing cirrhosis (16.7% in class A, 51.9% in class B, 86.8% in class C; p < 0.001). Women were affected more often than men (69.5 vs 48.7%; p = 0.001). Deficient patients had markedly lower HRQoL scores (mean SF-8: 29.1 +/- 6.8) compared with those with sufficient levels (17.2 +/- 4.5; p < 0.001). The poorest outcomes were seen in vitamin D-deficient females with class C disease. In regression analysis, vitamin D deficiency ( beta = 0.430, p < 0.001), advanced Child-Pugh stage (beta = 0.455, p < 0.001), and older age ( beta = 0.132, p = 0.001) were independent predictors of impaired HRQoL, whereas gender lost significance after adjustment. Conclusion: Vitamin D deficiency is widespread among cirrhotic patients, with a higher burden in women and in advanced disease. Both deficiency and disease severity independently contribute to reduced quality of life. Incorporating vitamin D screening and supplementation into cirrhosis care may be beneficial, and randomized trials are warranted to assess clinical impact.