Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Severity assessment criteria for acute cholangitis

Grade III (severe) acute cholangitis
Onset of dysfunction at least in any one of the
following organs/systems:
-Cardiovascular dysfunction: hypotension requiring dopamine ≥5 lg/kg per min, or any dose of norepinephrine
-Neurological dysfunction: disturbance of consciousness
-Respiratory dysfunction: PaO2/FiO2 ratio <300
-Renal dysfunction: oliguria, serum creatinine >2.0 mg/dl
-Hepatic dysfunction: PT-INR >1.5
-Hematological dysfunction: platelet count <100,000/mm3

Grade II (moderate) acute cholangitis
“Grade II” acute cholangitis is associated with any two of the following conditions:
-Abnormal WBC count (>12,000/mm3, <4,000/mm3)
-High fever (≥39°C)
-Age (≥75 years)
-Hyperbilirubinemia (total bilirubin ≥5 mg/dl)
-Hypoalbuminemia (<STD 9 0.7)

Grade I (mild) acute cholangitis
“Grade I” acute cholangitis does not meet the criteria of “Grade III (severe)” or “Grade II (moderate)” acute cholangitis at initial diagnosis
Cited from Kiriyama et al.

References:

Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Gomi H, Solomkin JS, Schlossberg D, Han HS, Kim MH, Hwang TL, Chen MF, Huang WS, Kiriyama S, Itoi T, Garden OJ, Liau KH, Horiguchi A, Liu KH, Su CH, Gouma DJ, Belli G, Dervenis C, Jagannath P, Chan ACW, Lau WY, Endo I, Suzuki K, Yoon YS, de Santibañes E, Giménez ME, Jonas E, Singh H, Honda G, Asai K, Mori Y, Wada K, Higuchi R, Watanabe M, Rikiyama T, Sata N, Kano N, Umezawa A, Mukai S, Tokumura H, Hata J, Kozaka K, Iwashita Y, Hibi T, Yokoe M, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40. doi: 10.1002/jhbp.509. Epub 2018 Jan 8. PMID: 28941329.