Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;37(5):434-442.
doi: 10.1159/000516424. Epub 2021 Jun 8.

Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality

Ramkumar Mohan  1 , Stefanie Wei Lynn Goh  2 , Guan Wei Tan  2 , Yen Pin Tan  3 , Sameer P Junnarkar  3 , Cheong Wei Terence Huey  1   3 , Jee Keem Low  3 , Vishal G Shelat  1   3
Affiliations

Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality

Ramkumar Mohan et al. Visc Med. 2021 Oct.

Abstract

Background: Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC.

Methods: This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality.

Results: Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8-82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; p < 0.006). The majority of the patients (n = 178; 67.9%) presented with abdominal pain, pyrexia (n = 156; 59.5%), and vomiting (n = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354-116.015; p = 0.026), systolic blood pressure <100 mm Hg (OR = 10.108; 95% CI 1.094-93.395; p = 0.041), Glasgow coma score <15 (OR = 38.16; 95% CI 1.804-807.191; p = 0.019), and malignancy (OR = 14.135; 95% CI 1.017-196.394; p = 0.049) predicted in-hospital mortality.

Conclusion: TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure <100 mm Hg, Glasgow coma score <15, and malignant etiology predict in-hospital mortality in patients with AC. These predictors could be considered in acute stratification and treatment of patients with AC.

Keywords: Acute cholangitis; Biliary disease; Sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Factors associated with a definite diagnosis of AC.
See this image and copyright information in PMC

References

    1. Kama NA, Atli M, Doganay M, Kologlu M, Reis E, Dolapci M. Practical recommendations for the prediction and management of common bile duct stones in patients with gallstones. Surg Endosc. 2001 Sep;15((9)):942–5. - PubMed
    1. Wang Z, Ahmed S, Shelat VG, Acute Cholangitis . In: Abdominal Sepsis: A Multidisciplinary Approach. Sartelli M, Bassetti M, Martin-Loeches I, editors. Springer International Publishing; 2018. pp. pp. 65–81.
    1. Andrew DJ, Johnson SE. Acute suppurative cholangitis, a medical and surgical emergency. A review of ten years experience emphasizing early recognition. Am J Gastroenterol. 1970 Aug;54((2)):141–54. - PubMed
    1. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14((1)):52–8. - PMC - PubMed
    1. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, et al. Tokyo Guidelines Revision Committee New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012 Sep;19((5)):548–56. - PMC - PubMed