The West Haven Criteria is a clinical grading system used to classify the severity of hepatic encephalopathy (HE) — a decline in brain function due to severe liver disease and accumulation of toxins like ammonia in the bloodstream.
| Grade | Clinical Features | Mental Status | Neuromuscular Signs |
|---|---|---|---|
| Grade 0 (Minimal HE) | No detectable changes on clinical exam; subtle cognitive/motor changes detectable by psychometric testing. | Normal consciousness | Normal |
| Grade I (Mild) | Trivial lack of awareness, euphoria or anxiety, shortened attention span, impaired performance of addition or subtraction. | Alert and oriented | Tremor, incoordination |
| Grade II (Moderate) | Lethargy, apathy, disorientation to time, personality change, inappropriate behavior. | Lethargic | Asterixis (flapping tremor), slurred speech |
| Grade III (Severe) | Somnolence to semi-stupor but responsive to stimuli, confusion, gross disorientation. | Stuporous | Hyperreflexia, rigidity, asterixis often absent |
| Grade IV (Coma) | Unresponsive to pain, no verbal response. | Coma | No response, decerebrate posture may appear |
