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Background/Aims: Heart rate variability (HRV) is reduced in several clinical settings associated with either systemic inflammation or neuropsychiatric impairment. The possibility that the changes in HRV observed in patients with neuropsychiatric impairment might relate to the overproduction of inflammatory cytokines does not seem to have been considered in the studies undertaken to date. HRV is decreased in patients with liver cirrhosis but its relationship to the impairment of neuropsychiatric performance, commonly observed in these patients, is unknown. The aim of this study was to investigate the relationship between HRV, hepatic encephalopathy and production of inflammatory cytokines in patients with cirrhosis. Methods: Eighty patients with cirrhosis (53 men, 27 women; mean [Â±1SD] age 54Â±10 yr), classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy, and 11 healthy subjects were studied. HRV was assessed by applying PoincarÃ© plot analysis to the R-R interval series on a five minute ECG. Inflammatory cytokines (TNF-alpha, IL-6, IL-10, and IL-12) were measured in a subgroup of patients. Results: Long-term R-R variability was significantly decreased in the patients with cirrhosis, in parallel with the degree of neuropsychiatric impairment (p
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