Digestive Diseases and Sciences

, Volume 53, Issue 2, pp 529–538

Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA)

  • Tarek I. Hassanein
  • Robin C. Hilsabeck
  • William Perry
Original Paper


A primary obstacle to early diagnosis and treatment of hepatic encephalopathy (HE) is the lack of a well-validated, standardized assessment method. The purpose of this study was to present preliminary validity data on a new method of grading HE, the Hepatic Encephalopathy Scoring Algorithm (HESA), which combines clinical impressions with neuropsychological performances to characterize HE. Participants were 49 inpatients admitted for complications of end stage liver disease. Each participant’s level of HE was graded using HESA and the West Haven Criteria (WHC) by independent raters blinded to each other’s rating. A moderately strong association was found between the two grading methods (r = 0.60), and individual HESA clinical and neuropsychological indicators were good discriminators among grades. The results also suggest HESA may be more sensitive to mental status impairment in the middle grades of HE than WHC. These findings suggest HESA holds promise as a multi-method approach to grading all levels of HE.


Chronic liver disease Cognitive impairment End stage liver disease Hepatitis C Hepatic encephalopathy Neuropsychological assessment 


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Tarek I. Hassanein
    • 1
  • Robin C. Hilsabeck
    • 2
  • William Perry
    • 2
  1. 1.Department of Medicine, Hepatology Neurobehavioral Research Program, UCSD Liver CenterUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Psychiatry, Hepatology Neurobehavioral Research Program, UCSD Liver CenterUniversity of CaliforniaSan DiegoUSA

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