Table 4.
Severity assessment criteria for acute cholecystitis
| (A) Proposed at International Meeting | |
| “Severe (grade III)” acute cholecystitis | |
| “Severe (grade III)” acute cholecystitis is associated with any one of the following categories. Organ/System dysfunction (Note: Thresholds were not discussed at the Summary session) | |
| • | Cardiovascular Hypotension |
| • | Neurologic (Disturbance of consciousness) |
| • | Respiratory (PaO2/FiO2 ratio <300) |
| • | Renal (Oliguria, creatinine >2.0 mg/dl) |
| • | Hepatic (T. bilirubin >5.0 mg/dl) |
| • | DIC (Platelets <100000/mm3) |
| Severe local inflmmation | |
| Biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis | |
| “Moderate (grade II)” acute cholecystitis | |
| “Moderate (grade II)” acute cholecystitis is associated with any of the following conditions. | |
| • | WBC > 15000, 18000 (Threshold?) |
| • | Palpable inflammatory mass |
| • | Onset > 72–96 h |
| • | Serious thickening? (or “erious” deleted?), thickening of wall (include threshold?, if so, what thickness — 6–7 mm or 8 mm? or twice normal gallbladder wall?) and fluid collection around the gallbladder. (Is both thickness of gallbladder wall and fluid collection around the gallbladder necessary?) |
| Liver cirrhosis should be described in a Note. | |
| “Mild (grade I)” acute cholecystitis | |
| “Mild (grade I)” acute cholecystitis does not meet the criteria of “severe” or “moderate” acute cholecystitis | |
| (B) Final version of severity assessment criteria for acute cholecystitis | |
| Mild (grade I) acute cholecystitis | |
| “Mild (grade I)” acute cholecystitis does not meet the criteria of “severe (grade III)” or “moderate (grade II)” acute cholecystitis. It can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure. | |
| Moderate (grade II) acute cholecystitis | |
| “Moderate” acute cholecystitis is 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 ha |
| 4. | Marked local inflammation (biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis) |
| a Laparoscopic surgery should be performed within 96 h of the onset of acute cholecystitis | |
| Severe (grade III) acute cholecystitis | |
| “Severe” acute cholecystitis is 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 dobutamine) |
| 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 <100000/mm3) |