Assessment of severity of acute cholangitis

Severity assessment criteria for acute cholangitis

Acute cholangitis in a patient may present with varying severity - from self-limiting to severe and/or potentially life-threatening diseases.

Assessment criteria are detailed below:

Grade III (Severe) acute cholangitis

• acute cholangitis that is associated with the onset of dysfunction in at least one of any of the following organs/systems:
  • cardiovascular dysfunction - hypotension requiring dopamine ≥5 µg/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
  • haematological dysfunction Platelet count<100,000/mm

Grade II (moderate) acute cholangitis

• acute cholangitis associated with any two of the following conditions:
• abnormal WBC count (>12,000/mm3, <4,000/mm3)
• high fever (>=39°C)
• age (>=75 years old)
• hyperbilirubinemia (total bilirubin ≥5 mg/dL)
• hypoalbuminemia (<STD x 0.7)

Grade I (mild) acute cholangitis

• acute cholangitis that does not meet the criteria of 'Grade III (severe)' or 'Grade II (moderate)' acute cholangitis at initial diagnosis

.Notes

• early diagnosis, early biliary drainage and/or treatment for aetiology, and antimicrobial administration are fundamental treatments for acute cholangitis classified not only as Grade III (severe) and Grade II (moderate) but also Grade I (mild)
• therefore, it is recommended that patients with acute cholangitis who do not respond to the initial medical treatment (general supportive care and antimicrobial therapy) undergo early biliary drainage or treatment for aetiology (1)

Reference:

1. Kiriyama S et al. TG13 guidelines for diagnosing and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):24-34