Severe acute cholangitis — classified as Grade III — is defined by biliary infection that has triggered dysfunction in at least one major organ or system. This page describes the clinical criteria for this scenario and provides access to the evidence-based management protocol.

Clinical Scenario

This protocol applies to patients with severe (Grade III) acute cholangitis in whom at least one of the following organ-system dysfunctions is present:

Cardiovascular: hypotension requiring dopamine ≥5 µg/kg per min, or any dose of norepinephrine
Neurological: disturbance of consciousness
Respiratory: PaO₂/FiO₂ ratio <300
Renal: oliguria, or serum creatinine >2.0 mg/dl
Hepatic: PT-INR >1.5
Hematological: platelet count <100,000/mm³

Treatment Approach

When treatment of the underlying biliary etiology is still required, an interventional or surgical approach is central to management — the complete protocol details which modality applies and under what conditions.

Full decision algorithm, procedural guidance, and complete regimen are available in the structured protocol below.

References

"Grade III" acute cholangitis is defined as acute cholangitis that is associated with the onset of dysfunction in at least any one of the following organs/systems:

Cardiovascular dysfunction: hypotension requiring dopamine ≥5 µg/kg per min, or any dose of norepinephrine

Neurological dysfunction: disturbance of consciousness

Respiratory dysfunction: PaO2/FiO2 ratio <300

Renal dysfunction: oliguria, serum creatinine >2.0 mg/dl

Hepatic dysfunction: PT-INR >1.5

Hematological dysfunction: platelet count <100,000/mm3

Treatment for etiology if still needed (endoscopic treatment, percutaneous treatment, or surgery)

DOI: 10.1002/jhbp.509

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Treatment of Severe Acute Cholangitis (Grade III) with Onset of Organ Dysfunction

Clinical Scenario

Treatment Approach

References