Prospective Assessment of Clinical Criteria for Diagnosis and Severity of Acute Cholangitis

BACKGROUND AND AIMS:Reliable tools to diagnose and prognosticate acute cholangitis are needed to improve patient outcomes. We assessed the accuracy of 2 clinical criteria, Tokyo and BILE criteria, for the diagnosis and severity of acute cholangitis. METHODS:We identified all patients from 2020-2021 seen at our institution with suspected cholangitis, defined as having abdominal pain or fever, and abnormal liver enzymes or biliary abnormality on imaging studies. Patient medical records were reviewed, and demographics, laboratory results, imaging findings, and procedure results were collected. To ascertain clinical outcomes, patients were followed until hospital discharge or for 30 days after presentation. RESULTS:During the study period, 175 patients with suspected acute cholangitis were prospectively identified. The average patient age was 69.6 years, 50.3% were women, and 115 met criteria standard for diagnosis of acute cholangitis. Intensive care admissions in 14.3%, mortality in 5.7%, and 30-day readmissions in 7.4% were observed. Tokyo diagnostic criteria for definite cholangitis had higher accuracy (64%), sensitivity (69.6%), and specificity (53.3%) when compared with BILE criteria, with an accuracy of 48.6% (P = 0.005), sensitivity of 42.61%, and specificity of 60%. Both criteria performed better in patients with choledocholithiasis (80% and 51% accuracy) than in patients with preexisting biliary stents (56% and 41% accuracy). The Tokyo severity grading criteria for severe cholangitis had an accuracy of 67.83% and was highly predictive of in-hospital mortality and ICU admission, but not 30-day readmission. CONCLUSION:Tokyo criteria were more accurate than BILE criteria for acute cholangitis; however, neither criteria achieved high diagnostic accuracy, especially in patients with preexisting biliary stents.