Severity of acute cholecystitis

A method for classification of severity acute cholecystitis has been suggested:

• grade III (severe) acute cholecystitis
  • associated with dysfunction of any one of the following organs/systems:
    • cardiovascular dysfunction - hypotension requiring treatment with dopamine ≥5 µg/kg per min, or any dose of norepinephrine
    • neurological dysfunction - decreased level of consciousness
    • respiratory dysfunction - PaO2/FiO2 ratio <300
    • renal dysfunction - oliguria, creatinine >2.0 mg/dl
    • hepatic dysfunction - PT-INR>1.5
    • hematological dysfunction - platelet count <100,000/mm3
      
• grade II (moderate) acute cholecystitis
  • associated with any one of the following conditions:
    • elevated white blood cell count (>18,000/mm3)
    • palpable tender mass in the right upper abdominal quadrant
    • duration of complaints >72 h
    • marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)
      
• grade I (mild) acute cholecystitis
  • does not meet the criteria of 'Grade III' or 'Grade II' acute cholecystitis
  • grade I 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 (1)

Reference:

1. Yokoe M, et al.Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Epub 2018 Jan 9. PMID: 29032636.