Tokyo Guidelines 2018: acute cholangitis

The Tokyo Guidelines 2018 (TG18) criteria for diagnosing acute cholangitis and grading its severity, which guides the timing of biliary drainage.

A. Systemic inflammationFever above 38 °C and/or shaking chillsInflammatory response: white cells below 4 or above 10 × 10⁹/L, or CRP 10 mg/L or more

B. CholestasisJaundice: bilirubin 34 µmol/L (2 mg/dL) or moreALP, GGT, AST or ALT above 1.5 times the upper limit of normal

C. ImagingBiliary dilatationCause on imaging: stricture, stone or stent

Organ dysfunction (grade III, severe)Hypotension needing dopamine 5 µg/kg/min or more, or any noradrenalineDisturbance of consciousnessPaO₂/FiO₂ below 300Oliguria, or creatinine above 177 µmol/L (2.0 mg/dL)INR above 1.5Platelets below 100 × 10⁹/L

Grade II (moderate) features: any twoWhite cells above 12 or below 4 × 10⁹/LFever 39 °C or higherAge 75 or overBilirubin 85 µmol/L (5 mg/dL) or moreAlbumin below 0.7 times the lower limit of normal

Enter the values above.

Diagnosis

Suspected: one item in A plus one item in B or C. Definite: one item in each of A, B and C.

Reference

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):17-30.