Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study
Journal
Journal of Hepato-Biliary-Pancreatic Sciences
Journal Volume
24
Journal Issue
6
Pages
329-337
Date Issued
2017
Author(s)
Kiriyama S.
Takada T.
Hwang T.-L.
Akazawa K.
Miura F.
Gomi H.
Mori R.
Endo I.
Itoi T.
Yokoe M.
Chen M.-F.
Jan Y.-Y.
Ker C.-G.
Wada K.
Yamaue H.
Miyazaki M.
Yamamoto M.
Abstract
Background: The Tokyo Guidelines 2007 (TG07) first presented the diagnostic and severity grading criteria for acute cholangitis. Subsequently updated in 2013, the Tokyo Guidelines (TG13) have been widely adopted throughout the world as global standard guidelines. We set out to verify the efficacy of these TG13 criteria in an international multicenter study. Methods: We reviewed 6,063 patients who were clinically diagnosed with acute cholangitis in Japan and Taiwan over a 2-year period. The TG13 diagnostic and severity grading criteria were retrospectively applied, and 30-day mortality was investigated. Results: A diagnosis of acute cholangitis was made in 5,454 (90.0%) patients on the basis of the TG13 criteria, and in 4,815 (79.4%) patients on the basis of the TG07 criteria. The 30-day mortality rates of patients with Grade III, Grade II, and Grade I were 5.1%, 2.6%, and 1.2%, respectively, and increased significantly along with disease severity. The mortality rate in the 1,272 Grade II cases where urgent or early biliary drainage was performed was 2.0% (n = 25), which was significantly lower than that of 3.7% (n = 28) in the other 748 cases. Conclusion: By using the TG13 diagnostic and severity grading criteria, more patients with possible acute cholangitis can be diagnosed, and patients whose prognosis can potentially be improved by early biliary drainage can be identified. The TG13 criteria are appropriate and useful for clinical practice. ? 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery
Subjects
Acute cholangitis; Diagnostic criteria; Guidelines; Severity grading criteria
SDGs
Other Subjects
acute cholangitis; aged; Article; biliary tract drainage; cholangitis; controlled study; disease classification; disease severity; female; human; Japan; major clinical study; male; mortality rate; observational study; prognosis; retrospective study; Taiwan; Tokyo Guidelines 2007 criteria; Tokyo Guidelines 2013 criteria; acute disease; cholangitis; clinical trial; cohort analysis; diagnostic imaging; Doppler ultrasonography; immunohistochemistry; incidence; international cooperation; middle aged; multicenter study; multivariate analysis; needle biopsy; pathology; procedures; risk assessment; severity of illness index; statistical model; survival rate; very elderly; x-ray computed tomography; Acute Disease; Aged; Aged, 80 and over; Biopsy, Needle; Cholangitis; Cohort Studies; Drainage; Female; Humans; Immunohistochemistry; Incidence; Internationality; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Taiwan; Tomography, X-Ray Computed; Ultrasonography, Doppler
Publisher
Blackwell Publishing Asia
Type
journal article