ToolsCalculators
West Haven criteria for hepatic encephalopathy
Grades severity of overt hepatic encephalopathy.
West Haven criteria for hepatic encephalopathy
Mental state and neuromuscular findings
ResultGrade 0
No clinically apparent encephalopathy (grade 0). Changes, if any, are detectable only on psychometric or neurophysiological testing (minimal / covert HE).
- Classification
- Covert / minimal HE
When to use
- Grading and tracking the severity of hepatic encephalopathy in patients with cirrhosis or acute liver failure.
- Grades 2 and above define overt encephalopathy under the 2014 AASLD/EASL classification.
Formula
Single ordinal grade 0-4 assigned from the highest-severity mental-state and neuromuscular findings observed. Grade 0-1 = covert; grade 2-4 = overt.
Pearls and pitfalls
- Asterixis is characteristic of grades 1-3 but disappears in deep coma (grade 4).
- Always search for a precipitant (infection, GI bleed, constipation, electrolyte disturbance, sedatives).