| [ Summary ] |
Charcot's triad has traditionally been used to diagnose acute cholangitis. Since their publication in the 2007 Tokyo Guidelines for management of acute cholangitis and cholecystitis (TG07), the diagnostic and severity assessment criteria for acute cholangitis have become the primary standard used worldwide. The diagnostic criteria have been updated through clinical implementation and assessment in multicenter analyses. The revised diagnostic criteria for acute cholangitis include clinical and laboratory signs of cholestasis and inflammation in addition to imaging findings which indicate biliary manifestations. The severity assessment criteria proposed in the TG07, which called for determining grades II and I at the time of diagnosis, proved impossible and therefore unsuitable for clinical use. Therefore, severity assessment criteria described in the 2013 revised Tokyo Guidelines (TG13) maintain the timing of biliary drainage and treatment of the disease etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis have been identified : (1) hyperbilirubinemia, (2) high fever, (3) leukocytosis, (4) advanced patient age, (5) hypoalbuminemia. Grade II acute cholangitis can be diagnosed if two of these five factors are present. |