West Haven Criteria

Name: West Haven Criteria calculator — MedScore
Creator: Nabil Alzein

Grade of overt hepatic encephalopathy (AASLD/EASL 2014)

West Haven grade

Tap the one that applies — its meaning opens right below.

1 — trivial lack of awareness, euphoria or anxiety, shortened attention span, impaired addition or subtraction

2 — lethargy or apathy, minimal disorientation for time or place, subtle personality change, inappropriate behaviour, asterixis

3 — somnolence to semi-stupor but responsive to verbal stimuli, confusion, gross disorientation

4 — coma, unresponsive to verbal or noxious stimuli

About this score

When to use

Grades overt hepatic encephalopathy in chronic liver disease from grade 1 to 4 (West Haven criteria). ⁦[1]⁩

Pearls and pitfalls

Minimal encephalopathy and grade 1 together are called covert; grades 2–4 are overt. ⁦[1]⁩

Summarised from the numbered sources under Evidence. Check the source before relying on a statement.

Evidence

[1] Original publication

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. Grades overt hepatic encephalopathy by the West Haven criteria (grades 1–4); minimal HE and grade 1 together are called covert, grades 2–4 overt.

Hepatology, 2014

Open source

Last reviewed: 2026-10

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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.