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Table 1 Diagnostic criteria for acute cholecystitis according to the Tokyo Guidelines [11]

From: Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial

Severity grade Criteria
Mild (grade I) Does not meet the criteria of “severe” or “moderate” acute cholecystitis. Can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder.
Moderate (grade II) Associated with any one of the following conditions:
 1. Elevated white blood cell count (>18,000/mm3)
 2. Palpable tender mass in the right upper abdominal quadrant
 3. Duration of complaints > 72 h
 4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)
Severe (grade III) Associated with dysfunction of any of the following organs/systems:
 1. Cardiovascular dysfunction (hypotension requiring treatment with dopamine > 5 μg/kg/minute or any dose of norepinephrine)
 2. Neurological dysfunction (decreased level of consciousness)
 3. Respiratory dysfunction (PaO2/FiO2 ratio < 300)
 4. Renal dysfunction (oliguria, creatinine > 2.0 mg/dl)
 5. Hepatic dysfunction (PT-INR > 1.5)
 6. Hematological dysfunction (platelet count < 100,000/mm3)
  1. Abbreviations: PaO 2 /FiO 2 Ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, PT-INR Prothrombin time-international normalized ratio