Cholangitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]
Overview
Acute cholangitis is classified into grade I, II and III depending on the severity of the condition.
Classification
The severity assessment criteria for acute cholangitis according to Tokyo guidelines is as follows.[1]
Grade III Acute Cholangitis
Grade III or severe acute cholangitis is characterized by the onset of dysfunction in at least one of the following:
- Cardiovascular system: decreased blood pressure that necessitate the administration of dopamine (>5 μg/kg/min) or norepinephrine
- Neurological system: abnormal consciousness
- Respiratory system: PaO2/FiO2 ratio <300
- Renal system: serum creatinine >2.0 mg/dl, decreased urine output
- Hepatic system: PT-INR >1.5
- Hematological system: platelet count < 100,000/mm3
Grade II Acute Cholangitis
Grade II or moderate acute cholangitis is characterized by the presence of any two of the following:
- Abnormal WBC count: >12,000/mm3, <4,000/mm3
- Fever ≥39°C
- Age ≥75 years
- Elevated total bilirubin ≥5 mg/dl
- Decreased albumin level <0.7 x STD
Grade I Acute Cholangitis
Grade I or mild acute cholangitis does not meet the criteria of neither grade II (moderate) or grade III (severe) acute cholangitis.