Gastroenterology · ICU and Critical Care · Surgery
Tokyo Guidelines 2018 Acute Cholecystitis calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 0–100 ×10⁹/L
Grade II includes a count above 18,000/mm³. A count above that also counts as an elevated leukocyte finding for diagnosis.
Allowed range: 0–720 h
Grade II includes complaints for more than 72 hours. The table footnote recommends laparoscopic surgery within 96 hours of onset.
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
Result
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Clinical inputs
- Murphy sign
- Right-upper-quadrant mass, pain, or tenderness
- Fever
- Elevated C-reactive protein
- Elevated leukocyte count
- Imaging characteristic of acute cholecystitis
- Leukocyte count (/mm³)Accepted range: 0 to 100000
- Palpable tender mass in the right upper quadrant
- Duration of complaints (h)Accepted range: 0 to 720
- Marked local inflammation
- Hypotension needing dopamine at least 5 µg/kg/min or any norepinephrine
- Decreased level of 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
Primary source
Yokoe M et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. DOI: 10.1002/jhbp.515. PMID: 29032636. Tables 1 and 7, adopted unchanged from TG13. Suspected = one local sign plus one systemic sign. Definite = those plus imaging characteristic of acute cholecystitis. Local signs are Murphy sign or right-upper-quadrant mass, pain, or tenderness. Systemic signs are fever, elevated CRP, or elevated WBC; the diagnostic table prints no numeric cutoff for those three. Grade III = any one of dopamine ≥5 µg/kg/min or any norepinephrine, decreased consciousness, PaO2/FiO2 <300, oliguria or creatinine >2.0 mg/dL, PT-INR >1.5, platelets <100 ×10⁹/L. Grade II = any one of WBC >18,000/mm³, a palpable tender right-upper-quadrant mass, complaints for more than 72 hours, or marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis). Grade I = neither. (2018)
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