Gastroenterology · ICU and Critical Care · Surgery
Tokyo Guidelines 2018 Acute Cholangitis calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 86–109.4 °F
A fever finding is a temperature above 38°C. Grade II uses 39°C or higher.
Allowed range: 0–100 ×10⁹/L
Diagnostic inflammation is under 4 or over 10 ×10⁹/L. A grade II factor is over 12 or under 4 ×10⁹/L.
Allowed range: 0–50 mg/dL
Allowed range: 0–40 mg/dL
Allowed range: 0–50 ×ULN
Cholestasis includes any of these enzymes above 1.5 times the upper reference limit.
Allowed range: 0–50 ×ULN
Allowed range: 0–50 ×ULN
Allowed range: 0–50 ×ULN
Allowed range: 0–120 years
Allowed range: 0–700 ratio
Leave blank if it was not measured. Grade III uses a ratio below 300.
Allowed range: 0–20 mg/dL
Allowed range: 0.5–10 ratio
Allowed range: 0–1000 ×10⁹/L
Allowed range: 0.5–6 g/dL
Hypoalbuminemia is albumin below 0.7 times that lower reference limit.
Allowed range: 0.5–6 g/dL
Result
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Clinical inputs
- Body temperature (°C)Accepted range: 30 to 43
- Shaking chills
- Leukocyte count (×10⁹/L)Accepted range: 0 to 100
- C-reactive protein (mg/dL)Accepted range: 0 to 50
- Total bilirubin (mg/dL)Accepted range: 0 to 40
- Alkaline phosphatase, times the upper reference limit (×ULN)Accepted range: 0 to 50
- Gamma-glutamyltransferase, times the upper reference limit (×ULN)Accepted range: 0 to 50
- Aspartate aminotransferase, times the upper reference limit (×ULN)Accepted range: 0 to 50
- Alanine aminotransferase, times the upper reference limit (×ULN)Accepted range: 0 to 50
- Biliary dilatation on imaging
- Cause seen on imaging (stone, stricture, or stent)
- Age (years)Accepted range: 0 to 120
- Hypotension needing dopamine at least 5 µg/kg/min or any norepinephrine
- Disturbed consciousness
- Arterial oxygen to inspired oxygen fraction (ratio)Accepted range: 0 to 700
- Oliguria
- Serum creatinine (mg/dL)Accepted range: 0 to 20
- Prothrombin time, international normalized ratioAccepted range: 0.5 to 10
- Platelet count (×10⁹/L)Accepted range: 0 to 1000
- Serum albumin (g/dL)Accepted range: 0.5 to 6
- Albumin lower reference limit from the same laboratory (g/dL)Accepted range: 0.5 to 6
Primary source
Kiriyama S et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci. DOI: 10.1002/jhbp.512. PMID: 29032610. Tables 2 and 4, adopted unchanged from TG13. Suspected = one systemic item plus cholestasis or imaging. Definite = one systemic item plus cholestasis plus imaging. Systemic: temperature >38°C or shaking chills, or WBC <4 or >10 ×10⁹/L, or CRP ≥1 mg/dL. Cholestasis: bilirubin ≥2 mg/dL, or ALP, GGT, AST, or ALT >1.5 × upper reference limit. Imaging: biliary dilatation or a visible cause. Grade III = any one of dopamine ≥5 µg/kg/min or any norepinephrine, disturbed consciousness, PaO2/FiO2 <300, oliguria or creatinine >2.0 mg/dL, PT-INR >1.5, platelets <100 ×10⁹/L. Grade II = any two of WBC >12 or <4 ×10⁹/L, temperature ≥39°C, age ≥75 years, bilirubin ≥5 mg/dL, albumin <0.7 × lower reference limit. Grade I = neither. (2018)
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