assessment of severity of acute cholangitis

Last reviewed 01/2018

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 - isturbance 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)

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