Beyond West Haven: Can mHEST Make Hepatic Encephalopathy Staging More Objective?: CGH | September 2026
Clinical knowledge base written and curated by GastroAGI Team from primary medical literatureLast updated September 1, 2026
What Did the Study Find?
The study evaluated the modified Hepatic Encephalopathy Staging Tool (mHEST) as a more objective alternative to conventional West Haven criteria.
- Among 49 clinicians from six countries, inter-rater agreement was dramatically higher with mHEST than West Haven (κ 0.934 vs 0.367).
- Clinical validation included 128 hospitalised patients with decompensated cirrhosis.
- Increasing mHEST grades showed a stepwise association with ammonia levels.
- Adding mHEST improved prognostic performance of the Child-Pugh and CLIF-C Organ Failure scores.
- Higher mHEST grades were also associated with greater 1-year mortality.
- Importantly, the FDA has accepted mHEST as an endpoint for clinical trials.
Why Does It Matter?
West Haven grading remains widely used but is subjective, particularly when distinguishing grade I from grade II HE—a distinction that can influence treatment and trial eligibility.
GastroAGI Takeaway
mHEST could bring much-needed reproducibility to HE staging. Its striking improvement in inter-observer agreement makes it particularly attractive for clinical trials and standardized communication. However, West Haven should not yet be abandoned: broader multicenter, real-world validation is required before mHEST becomes the routine bedside standard.
