Clinical applicability of Tokyo guidelines 2018/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model

Objective: To determine the diagnostic accuracy of Tokyo guidelines (TG) 2018/2013 (TG18/TG13) and predictors of poor prognosis in acute cholangitis.Methods: Retrospective 1-year study of consecutive hospital admissions for acute cholangitis. Prognosis was defined in terms of 30d in-hospital mortality.Results: Of the 183 patients with acute cholangitis, diagnostic accuracy based on Charcot's triad, TG07 and TG18/TG13 was 67.8, 86.9 and 92.3% (p<.001), respectively. Regarding severity based on TG18/TG13, 30.6% of cases were severe. A poor prognosis was found in 10.9% of patients. After multivariate analysis, systolic blood pressure <90mmHg (OR 11.010; p<.001), serum albumin <3g/dL (OR 1.355; p=.006), active oncology disease (OR 3.818; p=.006) and malignant aetiology of obstructive jaundice (OR 2.224; p=.021) were independent predictors of poor prognosis. The discriminative ability of the model with these four variables was high (AUROC 0.842; p<.001), being superior to TG18/TG13 (AUROC 0.693; p=.005).Conclusions: TG18/TG13 showed high diagnostic accuracy in acute cholangitis. Compared with TG18/TG13, the simplified severity model 2 allows easy selection of patients who will benefit from admission to the intensive care unit and early biliary decompression.