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

Abstract

Background and Aims Reliable tools to diagnose and prognosticate acute cholangitis are needed to improve patient outcomes. We assessed the accuracy of two clinical criteria, Tokyo and BILE criteria, for diagnosis and severity of acute cholangitis. Methods We identified all patients from 2020 – 21 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 study period, 175 patients with suspected acute cholangitis were prospectively identified. 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 of 53.3%, when compared to BILE criteria with accuracy 48.6% (p=0.005), sensitivity 42.61% and specificity 60%. Both criteria performed better in patients with choledocholithiasis (accuracy 80% and 51%) than in patients with pre-existing biliary stents (accuracy 56% and 41%). Tokyo severity grading criteria for severe cholangitis had 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 pre-existing biliary stents.