Classification of hepatic encaphalopathy

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)

Open Image in Modal

• 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.