tokyo_guidelines_cholangitis_2018: Tokyo Guidelines 2018 (TG18) for Acute Cholangitis

In cliot: Clinical Indices and Outcomes Tools

Tokyo Guidelines 2018 (TG18) for Acute Cholangitis

Description

Diagnoses and grades the severity of acute cholangitis based on the 2018 Tokyo Guidelines. Diagnosis requires evidence of systemic inflammation, cholestasis, and imaging findings. Severity is graded from I (Mild) to III (Severe) based on organ dysfunction and other risk factors.

Usage

tokyo_guidelines_cholangitis_2018(age, temperature_c, wbc_count, crp_elevated,
                                  bilirubin_mg_dl, abnormal_liver_enzymes,
                                  imaging_biliary_dilation, imaging_etiology,
                                  albumin_g_dl, hypotension_on_meds,
                                  altered_consciousness, pao2_fio2_lt_300,
                                  creatinine_mg_dl, inr, platelet_count_x10_9_l)

Arguments

age	Numeric. Patient age in years. (>= 75 contributes to Grade II).
temperature_c	Numeric. Body temperature in Celsius. (>38 contributes to diagnosis, >=39 contributes to Grade II).
wbc_count	Numeric. White Blood Cell count (x10^3/uL). (<4 or >10 contributes to diagnosis; <4 or >12 contributes to Grade II).
crp_elevated	Numeric (0 or 1). Is C-Reactive Protein (CRP) >= 1 mg/dL? (1 = Yes).
bilirubin_mg_dl	Numeric. Total Bilirubin in mg/dL. (>= 2 contributes to diagnosis; >= 5 contributes to Grade II).
abnormal_liver_enzymes	Numeric (0 or 1). Are ALP, GGT, AST, or ALT > 1.5x the upper limit of normal? (1 = Yes).
imaging_biliary_dilation	Numeric (0 or 1). Is there biliary dilation on imaging? (1 = Yes).
imaging_etiology	Numeric (0 or 1). Is there imaging evidence of etiology (e.g., stricture, stone, stent)? (1 = Yes).
albumin_g_dl	Numeric. Serum Albumin in g/dL. (< 0.7 x Lower Limit of Normal contributes to Grade II; standardized to approx < 2.45 g/dL).
hypotension_on_meds	Numeric (0 or 1). Hypotension requiring vasopressors? (1 = Yes, Grade III).
altered_consciousness	Numeric (0 or 1). Disturbance of consciousness? (1 = Yes, Grade III).
pao2_fio2_lt_300	Numeric (0 or 1). Is PaO2/FiO2 ratio < 300? (1 = Yes, Grade III).
creatinine_mg_dl	Numeric. Serum Creatinine in mg/dL. (> 2.0 contributes to Grade III).
inr	Numeric. INR. (> 1.5 contributes to Grade III).
platelet_count_x10_9_l	Numeric. Platelet count (x10^3/uL). (< 100 contributes to Grade III).

Value

A list containing:

Diagnosis	Diagnostic status (No, Suspected, or Definite Acute Cholangitis).
Severity_Grade	Severity Classification (Grade I, II, or III) if diagnosed.
Criteria_Status	List of booleans indicating which diagnostic criteria (A, B, C) were met.

References

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30. doi:10.1002/jhbp.512

Examples

# Example 1: Definite Acute Cholangitis, Grade III (Severe)
# Fever, High WBC, High Bili, Dilation, Hypotension
tokyo_guidelines_cholangitis_2018(65, 39.5, 15, 1, 3.0, 1, 1, 1, 3.0, 1, 0, 0, 1.0, 1.0, 150)

# Example 2: Suspected Acute Cholangitis, Grade I (Mild)
# Fever, Abnormal LFTs, No Imaging Findings, Stable Vitals/Labs
tokyo_guidelines_cholangitis_2018(50, 38.5, 9, 0, 1.5, 1, 0, 0, 4.0, 0, 0, 0, 0.8, 1.0, 200)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.