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Classification of hepatic encaphalopathy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Classification of hepatic encephalopathy

Several methods have been proposed for classification of HE. (1,2)

  • according to the underlying disease
    • type A - due to acute liver failure
    • type B - due to portal venous bypass with portosystemic shunting
    • type C - due to cirrhotic liver disease

  • according to the severity of manifestations
    • grading of HE has traditionally been defined by the West Haven Criteria (WHC), also known as the Conn score. Patients with grade 3 or 4 HE should also be monitored with the Glasgow coma scale (2)
  • according to its time course
    • episodic HE
    • recurrent HE denotes bouts of HE that occur with a time interval of 6 months or less.
    • persistent HE denotes a pattern of behavioural alterations that are always present and interspersed with relapses of overt HE

  • according to the existence of precipitating factors
    • non- precipitated or
    • precipitated, and the precipitating factors should be specified. Precipitating factors can be identified in nearly all bouts of episodic HE type C and should be actively sought and treated when found

References:

  1. 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
  2. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatic encephalopathy. J Hepatol. 2022 Sep;77(3):807-24.

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