Table 1 “Severity assessment criteria for acute cholecystitis”

I (mild)

Acute cholecystitis does not meet the criteria of “Grade III” or “Grade II”

It can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure.

II (moderate)

Acute cholecystitis is associated with any one of the following conditions:

1. Elevated white blood cell count (>18,000/mm3)

2. Palpable tender mass in the right upper abdominal quadrant

3. Duration of complaints > 72 hours

4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis).

III (severe)

“Grade III” (severe) acute cholecystitis is associated with dysfunction of any one of the following organs/systems

1. Cardiovascular dysfunction defined as hypotension requiring treatment with dopamine ≥ 5 μg/kg per min, or any dose of norepinephrine

2. Neurological dysfunction defined as decreased level of consciousness

3. Respiratory dysfunction defined as a PaO2/FiO2 ratio < 300

4. Renal dysfunction defined as oliguria, creatinine > 2.0 mg/dl

5. Hepatic dysfunction defined as PT-INR > 1.5

6. Hematological dysfunction defined as platelet count < 100,000/mm3