From: Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment
Grade | Definition |
---|---|
I (mild) | Acute cholangitis does not meet the criteria of “Grade II or III”, representing acute cholangitis at initial diagnosis. Notes |
Patients should have early diagnosis, biliary drainage and/or treatment for etiology, and antimicrobial administration. | |
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 etiology. | |
II (moderate) | Acute cholangitis associated with any two of the following conditions: |
1. Abnormal white blood cell count (>12,000/mm3, < 4,000/mm3) | |
2. High fever (≥39°C) | |
3. Age (≥75 years old) | |
4. Hyperbilirubinemia (total bilirubin ≥ 5 mg/dL) | |
5. Hypoalbuminemia (< STD × 0.7) | |
III (severe) | Acute cholangitis associated with the onset of dysfunction in at least one of any 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 |