Clinical Evaluation of the Severity Assessment Criteria of the JPN Guidelines 2013 and JPN Guidelines 2005 for Acute Cholangitis

Abstract

We evaluated severity assessment criteria of the updated JPN Guidelines 2013 (JPN 2013) and JPN 2005 for acute cholangitis (AC) and developed a new scoring system to predict a positive culture for bacteremia. We retrospectively reviewed 60 AC cases. According to the JPN 13, there were 11 severe, 23 moderate and 26 mild cases of AC. According to the JPN 2005, there were 20 severe, 36 moderate and 4 mild cases. Moderate AC tended to be overdiagnosed based on the JPN 2005, but the severity criteria for moderate AC in the TG 13 enabled differentiation between high-risk patients requiring early biliary drainage from mild-AC patients. When the five predictors of moderate AC in the JPN 2005 were used to devise a scoring system (maximum 5 points), the ROC curve of the scores showed good test performance for predicting a positive culture for bacteremia with an AUC of 0.89. The optimal cut-off value was 2 points and yielded a sensitivity of 90%and specificity of 74%. We concluded that the JPN 2013 have clearly resolved the problems of JPN 2005 and that the scoring system contributes to predict a positive culture for bacteremia.