🟢 Acute Cholecystitis Severity Grading (Tokyo TG18)
This tool grades acute cholecystitis severity (I/II/III) by the Tokyo Guidelines 2018, which links grade to organ dysfunction, local inflammation, and the appropriate management pathway.
Clinical takeaway
Grading is evaluated top-down — rule out Grade III, then Grade II, defaulting to Grade I — so a single organ dysfunction immediately defines severe disease. (original synthesis · not guideline verbatim)
Loading calculator…
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Use after diagnosing acute cholecystitis to assign a severity grade and choose between early cholecystectomy, percutaneous cholecystostomy, or organ support with urgent drainage.
How it works
Assess Grade III first (any organ dysfunction: cardiovascular/neurologic/respiratory/renal/hepatic/hematologic), then Grade II (WBC > 18,000, tender RUQ mass, duration > 72 h, or marked local inflammation); otherwise Grade I.
Key points
- Grading is evaluated top-down — rule out Grade III, then Grade II, defaulting to Grade I — so a single organ dysfunction immediately defines severe disease. (original synthesis · not guideline verbatim)
- This tool grades severity only; the diagnosis itself requires the TG18 triad of local signs, systemic inflammation, and imaging.
- Surgical timing and approach also weigh anesthetic risk (ASA/CCI) and team experience.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Grade III (severe): any organ dysfunction — cardiovascular (dopamine ≥ 5 or any norepinephrine), neurologic (altered consciousness), respiratory (PaO₂/FiO₂ < 300), renal (oliguria or Cr > 2.0 mg/dL), hepatic (PT-INR > 1.5), hematologic (platelets < 100,000) | None |
|---|---|
| Grade II (moderate): any — WBC > 18,000/µL, palpable tender RUQ mass, duration > 72 h, marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis) | None |
→TG18 gradeGrade I (mild)
- Grade：Grade I (mild) (assess III first, then II, otherwise I)
- Management direction：Antimicrobials + early (prompt) laparoscopic cholecystectomy
- Note：This tool only grades severity; diagnosing acute cholecystitis requires the TG18 diagnostic criteria (local inflammatory signs + systemic inflammation + imaging). Surgical timing and approach depend on patient status, anesthetic risk (e.g. ASA/CCI), and team conditions
| Grade III (severe): any organ dysfunction — cardiovascular (dopamine ≥ 5 or any norepinephrine), neurologic (altered consciousness), respiratory (PaO₂/FiO₂ < 300), renal (oliguria or Cr > 2.0 mg/dL), hepatic (PT-INR > 1.5), hematologic (platelets < 100,000) | ≥1 present |
|---|---|
| Grade II (moderate): any — WBC > 18,000/µL, palpable tender RUQ mass, duration > 72 h, marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis) | ≥1 present |
→TG18 gradeGrade III (severe)
- Grade：Grade III (severe) (assess III first, then II, otherwise I)
- Management direction：Organ support + urgent biliary drainage/cholecystostomy, manage definitively once stabilized; ICU management
- Note：This tool only grades severity; diagnosing acute cholecystitis requires the TG18 diagnostic criteria (local inflammatory signs + systemic inflammation + imaging). Surgical timing and approach depend on patient status, anesthetic risk (e.g. ASA/CCI), and team conditions
Frequently asked questions
- What is Acute Cholecystitis Severity Grading (Tokyo TG18)?
- This tool grades acute cholecystitis severity (I/II/III) by the Tokyo Guidelines 2018, which links grade to organ dysfunction, local inflammation, and the appropriate management pathway.
- How is Acute Cholecystitis Severity Grading (Tokyo TG18) calculated? What is the core formula?
- Assess Grade III first (any organ dysfunction: cardiovascular/neurologic/respiratory/renal/hepatic/hematologic), then Grade II (WBC > 18,000, tender RUQ mass, duration > 72 h, or marked local inflammation); otherwise Grade I.
- When is Acute Cholecystitis Severity Grading (Tokyo TG18) used?
- Use after diagnosing acute cholecystitis to assign a severity grade and choose between early cholecystectomy, percutaneous cholecystostomy, or organ support with urgent drainage.
- What are the key clinical points for Acute Cholecystitis Severity Grading (Tokyo TG18)?
- Grading is evaluated top-down — rule out Grade III, then Grade II, defaulting to Grade I — so a single organ dysfunction immediately defines severe disease. (original synthesis · not guideline verbatim) This tool grades severity only; the diagnosis itself requires the TG18 triad of local signs, systemic inflammation, and imaging. Surgical timing and approach also weigh anesthetic risk (ASA/CCI) and team experience.
- What are the limits and cautions when using Acute Cholecystitis Severity Grading (Tokyo TG18)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute Cholecystitis Severity Grading (Tokyo TG18) calculated in practice? Can you show a worked example?
- Inputs: Grade III (severe): any organ dysfunction — cardiovascular (dopamine ≥ 5 or any norepinephrine), neurologic (altered consciousness), respiratory (PaO₂/FiO₂ < 300), renal (oliguria or Cr > 2.0 mg/dL), hepatic (PT-INR > 1.5), hematologic (platelets < 100,000) None, Grade II (moderate): any — WBC > 18,000/µL, palpable tender RUQ mass, duration > 72 h, marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis) None → Result: TG18 grade Grade I (mild)（Grade: Grade I (mild) (assess III first, then II, otherwise I), Management direction: Antimicrobials + early (prompt) laparoscopic cholecystectomy, Note: This tool only grades severity; diagnosing acute cholecystitis requires the TG18 diagnostic criteria (local inflammatory signs + systemic inflammation + imaging). Surgical timing and approach depend on patient status, anesthetic risk (e.g. ASA/CCI), and team conditions） Inputs: Grade III (severe): any organ dysfunction — cardiovascular (dopamine ≥ 5 or any norepinephrine), neurologic (altered consciousness), respiratory (PaO₂/FiO₂ < 300), renal (oliguria or Cr > 2.0 mg/dL), hepatic (PT-INR > 1.5), hematologic (platelets < 100,000) ≥1 present, Grade II (moderate): any — WBC > 18,000/µL, palpable tender RUQ mass, duration > 72 h, marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis) ≥1 present → Result: TG18 grade Grade III (severe)（Grade: Grade III (severe) (assess III first, then II, otherwise I), Management direction: Organ support + urgent biliary drainage/cholecystostomy, manage definitively once stabilized; ICU management, Note: This tool only grades severity; diagnosing acute cholecystitis requires the TG18 diagnostic criteria (local inflammatory signs + systemic inflammation + imaging). Surgical timing and approach depend on patient status, anesthetic risk (e.g. ASA/CCI), and team conditions）