Acute Cholangitis Severity (Tokyo Guidelines TG18)
Acute cholangitis severity grade: Grade III if any one new-onset organ dysfunction; Grade II if any two of abnormal WBC, fever >= 39 C, age >= 75, bilirubin >= 5 mg/dL, or albumin < 0.7x lower limit of normal; Grade I otherwise.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Hepatic dysfunction
- Yes
Result: Grade III (severe) acute cholangitis: one organ dysfunction (hepatic, PT-INR > 1.5) makes it Grade III.
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What the result means
- I
- Mild: no organ dysfunction and fewer than two moderate criteria at initial diagnosis.
- II
- Moderate: any two of abnormal WBC, fever >= 39 C, age >= 75, bilirubin >= 5 mg/dL, or albumin < 0.7x lower limit of normal.
- III
- Severe: any one new-onset organ dysfunction (cardiovascular, neurological, respiratory, renal, hepatic, or hematological).
What you enter
- Cardiovascular dysfunction (dopamine >= 5 ug/kg/min or any norepinephrine)
- Neurological dysfunction (disturbance of consciousness)
- Respiratory dysfunction (PaO2/FiO2 ratio < 300)
- Renal dysfunction (oliguria or serum creatinine > 2.0 mg/dL)
- Hepatic dysfunction (PT-INR > 1.5)
- Hematological dysfunction (platelet count < 100,000/mm3)
- Abnormal WBC count (> 12,000 or < 4,000/mm3)
- High fever (>= 39 C)
The other 3 fields
- Age >= 75 years
- Hyperbilirubinemia (total bilirubin >= 5 mg/dL)
- Hypoalbuminemia (albumin < 0.7x lower limit of normal)
How this is calculated
Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):31-40 (Table 3, cited from Kiriyama et al.). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.