Clinical evaluation of the T okyo G uidelines 2013 for severity assessment of acute cholangitis

Background We evaluated the severity assessment criteria for acute cholangitis ( AC ) of the T okyo 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 .