Table 1.

Diagnosis criteria and severity classification of PPDC based on TG18

A. Systemic inflammation
A-1. Fever and/or shaking chills
A-2. Laboratory data: evidence of inflammatory response
B. Cholestasis
B-1. Jaundice
B-2. Laboratory data: abnormal liver function tests
C. Imaging
C-1. Biliary dilatation
C-2. Evidence of the etiology on imaging (stricture, stone, stent etc
Suspected diagnosis: one item in A + one item in either B or C
Definite diagnosis: one item in A, one item in B and one item in C
Thresholds:
A-1	Fever	BT > 38 °C
A-2	Evidence of inflammatory response	WBC counts: < 4000 or > 10,000 /μL CRP: > 1.0 mg/dL
B-1	Jaudice	T-bil: > 2.0 mg/dL
B-2	Abnormal liver function	ALP, γ-GTP, AST, ALT: > 1.5 times the institutional standard values

Severity classification and treatment
Severity	General condition	Diagnosis criteria
Mild	Not sick	Fever with mild laboratory abnormalities (cases that do not meet the criteria for moderate or severe cholangitis)
Moderate	A little tight	Presenting with two of the following events: Age ≥ 75 BT ≥ 39 ºC WBC count < 4000 or 12,000 T-bil ≥ 5 mg/dl Serum albumin level 0.73 × the standard value
Severe	Poor	Abnormalities suggestive of sepsis (associated with impairment of circulation, central nervous system, respiration, renal function, liver function, or coagulation)

PPDC post pancreaticoduodenectomy cholangitis, TG18 Tokyo Guideline 2018, BT body temperature, WBC white blood cells, CRP C-reactive protein, T-bil Total bilirubin, ALP alkaline phosphate, γ-GTP gamma-glutamyl transpeptidase, AST aspartate aminotransaminase, ALT alanine aminotransaminase