Hepatic Encephalopathy Grades/Stages Calculator
No clinically apparent changes in personality, awareness, or behavior. Subtle changes only detectable by specialized testing.
Mild lack of awareness, shortened attention span, impaired addition/subtraction, altered sleep rhythm, mood changes, mild asterixis may be present.
Lethargy, moderate confusion, disorientation to time, inappropriate behavior, obvious asterixis, slurred speech.
Somnolence but arousable, unable to perform mental tasks, disorientation to place, marked confusion, incomprehensible speech, hyperactive reflexes.
Coma, unresponsive to verbal or noxious stimuli, decerebrate posturing may be present.
Note:
This calculator uses the West Haven Criteria for grading hepatic encephalopathy. Clinical judgment should always be used alongside this tool.
What is Hepatic Encephalopathy?
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs as a complication of liver disease. It is characterized by a spectrum of neurological and psychiatric abnormalities ranging from subtle alterations in cognition to profound coma.
Clinical Significance
Grading hepatic encephalopathy helps clinicians to:
- Assess the severity of the condition
- Monitor disease progression
- Guide treatment decisions
- Predict outcomes
- Communicate effectively about patient status
West Haven Criteria
The West Haven criteria is the most widely used grading system for hepatic encephalopathy. It classifies HE into five grades (0-4) based on the level of consciousness, intellectual function, behavior, and neuromuscular signs.
Management Considerations
Treatment of hepatic encephalopathy depends on the grade and may include:
- Identification and treatment of precipitating factors
- Reduction of ammonia production (lactulose, rifaximin)
- Nutritional support
- Management of complications
- Consideration of liver transplantation in appropriate candidates
Limitations
The West Haven criteria has some limitations:
- Subjective assessment may lead to inter-observer variability
- Difficult to distinguish between grades 0 and 1 without specialized testing
- May not capture all aspects of neurological dysfunction
References
- Vilstrup H, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-35.
- Ferenci P, et al. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716-21.
- Bajaj JS, et al. Review article: the design of clinical trials in hepatic encephalopathy—an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement. Aliment Pharmacol Ther. 2011;33(7):739-47.