ToolsCalculators
Tokyo Guidelines for Acute Cholangitis 2018 (TG18)
Diagnostic criteria and severity grading for acute cholangitis.
Tokyo Guidelines for Acute Cholangitis 2018 (TG18)
A. Systemic inflammation (fever/chills or abnormal WBC / elevated CRP)
B. Cholestasis (jaundice with T-bil >=2 mg/dL, or ALP/GGT/AST/ALT >1.5x upper limit)
C. Imaging (biliary dilatation, or evidence of an etiology such as stricture, stone, or stent)
Grade III: organ dysfunction (vasopressor-requiring hypotension, altered consciousness, PaO2/FiO2 <300, creatinine >2 mg/dL, INR >1.5, or platelets <100k)
WBC >12,000 or <4,000 /uL
High fever >=39 C
Age >=75 years
Total bilirubin >=5 mg/dL
Hypoalbuminemia (<0.7x lower normal)
ResultDiagnostic criteria not met
Requires one item from A plus one from B or C to be suspected.
- Diagnosis
- Diagnostic criteria not met
When to use
- Confirming a diagnosis of acute cholangitis and grading its severity to guide the urgency of biliary drainage.
Formula
Suspected: one A item (systemic inflammation) plus one from B (cholestasis) or C (imaging). Definite: one from A, B, and C. Grade III = any organ dysfunction; Grade II = >=2 of (WBC >12k or <4k, fever >=39 C, age >=75, T-bil >=5 mg/dL, hypoalbuminemia); Grade I = neither.
Pearls and pitfalls
- Grade III (severe) cholangitis warrants urgent biliary drainage plus organ support.
- Grade II should prompt early rather than delayed drainage.