cliot (version 1.0.0)

tokyo_guidelines_cholangitis_2018: Tokyo Guidelines 2018 (TG18) for Acute Cholangitis

Description

Diagnoses and grades the severity of acute cholangitis based on the 2018 Tokyo Guidelines. Diagnosis requires evidence of systemic inflammation, cholestasis, and imaging findings. Severity is graded from I (Mild) to III (Severe) based on organ dysfunction and other risk factors.

Usage

tokyo_guidelines_cholangitis_2018(age, temperature_c, wbc_count, crp_elevated,
                                  bilirubin_mg_dl, abnormal_liver_enzymes,
                                  imaging_biliary_dilation, imaging_etiology,
                                  albumin_g_dl, hypotension_on_meds,
                                  altered_consciousness, pao2_fio2_lt_300,
                                  creatinine_mg_dl, inr, platelet_count_x10_9_l)

Value

A list containing:

Diagnosis

Diagnostic status (No, Suspected, or Definite Acute Cholangitis).

Severity_Grade

Severity Classification (Grade I, II, or III) if diagnosed.

Criteria_Status

List of booleans indicating which diagnostic criteria (A, B, C) were met.

Arguments

age

Numeric. Patient age in years. (>= 75 contributes to Grade II).

temperature_c

Numeric. Body temperature in Celsius. (>38 contributes to diagnosis, >=39 contributes to Grade II).

wbc_count

Numeric. White Blood Cell count (x10^3/uL). (<4 or >10 contributes to diagnosis; <4 or >12 contributes to Grade II).

crp_elevated

Numeric (0 or 1). Is C-Reactive Protein (CRP) >= 1 mg/dL? (1 = Yes).

bilirubin_mg_dl

Numeric. Total Bilirubin in mg/dL. (>= 2 contributes to diagnosis; >= 5 contributes to Grade II).

abnormal_liver_enzymes

Numeric (0 or 1). Are ALP, GGT, AST, or ALT > 1.5x the upper limit of normal? (1 = Yes).

imaging_biliary_dilation

Numeric (0 or 1). Is there biliary dilation on imaging? (1 = Yes).

imaging_etiology

Numeric (0 or 1). Is there imaging evidence of etiology (e.g., stricture, stone, stent)? (1 = Yes).

albumin_g_dl

Numeric. Serum Albumin in g/dL. (< 0.7 x Lower Limit of Normal contributes to Grade II; standardized to approx < 2.45 g/dL).

hypotension_on_meds

Numeric (0 or 1). Hypotension requiring vasopressors? (1 = Yes, Grade III).

altered_consciousness

Numeric (0 or 1). Disturbance of consciousness? (1 = Yes, Grade III).

pao2_fio2_lt_300

Numeric (0 or 1). Is PaO2/FiO2 ratio < 300? (1 = Yes, Grade III).

creatinine_mg_dl

Numeric. Serum Creatinine in mg/dL. (> 2.0 contributes to Grade III).

inr

Numeric. INR. (> 1.5 contributes to Grade III).

platelet_count_x10_9_l

Numeric. Platelet count (x10^3/uL). (< 100 contributes to Grade III).

References

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30. doi:10.1002/jhbp.512

Examples

# Example 1: Definite Acute Cholangitis, Grade III (Severe)
# Fever, High WBC, High Bili, Dilation, Hypotension
tokyo_guidelines_cholangitis_2018(65, 39.5, 15, 1, 3.0, 1, 1, 1, 3.0, 1, 0, 0, 1.0, 1.0, 150)

# Example 2: Suspected Acute Cholangitis, Grade I (Mild)
# Fever, Abnormal LFTs, No Imaging Findings, Stable Vitals/Labs
tokyo_guidelines_cholangitis_2018(50, 38.5, 9, 0, 1.5, 1, 0, 0, 4.0, 0, 0, 0, 0.8, 1.0, 200)