Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines

Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Sakai, Yuji; Nishikawa, Takao; Yokosuka, Osamu; Mayumi, Toshihiko; Kiriyama, Seiki; Yokoe, Masamichi; Takada, Tadahiro

doi:10.1007/s00534-012-0538-2

Cited by 34 publications

(52 citation statements)

References 22 publications

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“…Univariate analyses and/or multivariate analyses have been used to identify many prognostic factors for AC . In the present study we attempted to identify predictors of the need of urgent/early biliary drainage.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis

Nishino

Hamano

Mitsunaga

et al. 2014

J Hepatobiliary Pancreat Sci

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Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis

Nishino

Hamano

Mitsunaga

et al. 2014

J Hepatobiliary Pancreat Sci

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“…When acute cholecystitis is accompanied by acute cholangitis, the criteria for the severity assessment of acute cholangitis should also be taken into account [62, 63].…”

Section: Severity Assessment Criteria For Acute Cholecystitis; Tg13mentioning

confidence: 99%

TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)

Yokoe

Takada

Strasberg

et al. 2013

J Hepato Biliary Pancreat

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Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being Electronic supplementary material The online version of this article

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“…Factors which were inappropriate for use as items of severity assessment were excluded. Consequently, five factors—hypoalbuminemia, elderly patients, high fever, leukocytosis and hyperbilirubinemia—were extracted [8, 32]. Cases with two of these five factors present were classified as Grade II (moderate) [8].…”

Section: Introductionmentioning

confidence: 99%

TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)

Kiriyama

Takada

Strasberg

et al. 2013

J Hepato Biliary Pancreat

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266

289

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Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

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Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines

Abstract: The TG07 severity assessment criteria for acute cholangitis were significantly predictive of mortality. Hypoalbuminemia is an important risk factor in addition to organ dysfunction.

Cited by 34 publications

References 22 publications

Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis

Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis

TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)

TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)

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