Table 2.

Severity and classification of acute cholecystitis by the Tokyo guidelines 2018

Grade I (mild) acute cholecystitis:

1. Acute cholecystitis in a healthy patient without organ dysfunction 2. Inflammatory changes in the gallbladder are mild, making cholecystectomy a safe and low-risk procedure 3. Acute cholecystitis that does not meet the criteria for grade III or grade II cholecystitis

Grade II (moderate) acute cholecystitis, associated with any one of the following conditions:

1. Elevated WBC count (> 18,000/mm3) 2. Palpable tender mass in the right upper abdominal quadrant 3. Duration of complaints > 72 h 4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)

Grade III (severe) acute cholecystitis, associated with dysfunction of any one of the following organs/systems:

1. Cardiovascular dysfunction: hypotension requiring treatment with dopamine ≥ 5 µg/kg per min, or any dose of norepinephrine 2. Neurological dysfunction: decreased level of consciousness 3. Respiratory dysfunction: PaO2/FiO2 ratio < 300 4. Renal dysfunction: oliguria, creatinine > 2.0 mg/dl 5. Hepatic dysfunction: PT-INR > 1.5 6. Hematological dysfunction: platelet count < 100,000/mm3