title: Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis.
abstract: BACKGROUND
  We evaluated the severity assessment criteria for acute cholangitis (AC) of the Tokyo Guidelines 2013 (TG13) and developed a scoring system for predicting the need for urgent/early biliary drainage.
  
  
  METHODS
  We retrospectively reviewed 66 AC cases prospectively managed based on the TG07 and divided into an urgent/early biliary drainage group (n = 30) and elective biliary drainage group (n = 36).
  
  
  RESULTS
  There were 26 mild, 27 moderate, and 13 severe cases based on the TG13. The TG13 assessment in 12 of the 17 cases requiring early biliary drainage based on the TG07 was moderate, but underestimated the other five cases as mild AC. When five predictors (blood urea nitrogen >20 mg/dL, SIRS presence, platelet count <120 000/μL, serum albumin level <3.0 g/dL, age ≥75 years old) were used to devise a scoring system, the receiver-operator characteristic curve of the scores showed good test performance for predicting the need for urgent/early biliary drainage. The area under the curve (AUC) was 0.95 and higher than the TG13 AUC (0.80).
  
  
  CONCLUSIONS
  The TG13 is practical, but some AC cases requiring urgent/early biliary drainage were underestimated as mild AC. The scoring system allows identification of high-risk AC patients and will improve the TG13.
authors.affiliation: Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8542, Japan. tnishino@tymc.twmu.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nishino
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hamano
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mitsunaga
authors.forename: Izumi
authors.initials: I
authors.lastname: Shirato
authors.forename: Miho
authors.initials: M
authors.lastname: Shirato
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tagata
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shimada
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mitsunaga
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002761:Cholangitis / Q000473:pathology* / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014041:Tokyo
chemical_list: D015415:Biomarkers
keywords: Acute cholangitis; Bacteremia; Scoring system; Severity assessment; Tokyo Guidelines 2013