West Haven criteria for hepatic encephalopathy

WHC including MHE	ISHEN	Description	Suggested operative criteria	Comment
Unimpaired		No encephalopathy at all, no history of HE	Tested and proved to be normal
Minimal	Covert	Psychometric or neuropsychological alterations of tests exploring psychomotor speed/executive functions or neurophysiological alterations without clinical evidence of mental change	Abnormal results of established psychometric or neuropsychological tests without clinical manifestations	No universal criteria for diagnosis Local standards and expertise required
Grade I	Covert	Trivial lack of awareness Euphoria or anxiety Shortened attention span Impairment of addition or subtraction Altered sleep rhythm	Despite oriented in time and space (see below), the patient appears to have some cognitive/behavioral decay with respect to his or her standard on clinical examination or to the caregivers	Clinical findings usually not reproducible
Grade II	Overt	Lethargy or apathy Disorientation for time Obvious personality change Inappropriate behavior Dyspraxia Asterixis	Disoriented for time (at least three of the following are wrong: day of the month, day of the week, month, season, or year) ± the other mentioned symptoms	Clinical findings variable, but reproducible to some extent
Grade III		Somnolence to semistupor Responsive to stimuli Confused Gross disorientation Bizarre behavior	Disoriented also for space (at least three of the following wrongly reported: country, state [or region], city, or place) ± the other mentioned symptoms	Clinical findings reproducible to some extent
Grade IV		Coma	Does not respond even to painful stimuli	Comatose state usually reproducible

All conditions are required to be related to liver insufficiency and/or portosystemic shunting.

WHC: West Haven criteria; MHE: minimal hepatic encephalopathy; ISHEN: International Society for Hepatic Encephalopathy and Nitrogen Metabolism; HE: hepatic encephalopathy.

From: Vilstrup H, Amodio P, Bajaj J, 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; 60:715. http://onlinelibrary.wiley.com/doi/10.1002/hep.27210/abstract. Copyright © 2014 American Association for the Study of Liver Diseases. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (http://onlinelibrary.wiley.com).

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West Haven criteria for hepatic encephalopathy