West Haven Criteria for Hepatic Encephalopathy

The West Haven Criteria are the standard for grading hepatic encephalopathy (HE) severity, ranging from subclinical (Grade 0) to deep coma (Grade 4). Developed by Trey and Davidson in the 1960s and refined by the West Haven group, these criteria integrate mental status changes (confusion, asterixis, disorientation) and consciousness level to stage HE. The West Haven grade is a strong predictor of short-term prognosis in cirrhosis and guides urgency of intervention (lactulose, rifaxomicin, mannitol, intubation).