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Performance of Tokyo Guidelines 2018 and Predictors of Mortality in Acute Cholangitis Patients in Indonesia

ACTA MEDICA INDONESIANA · Vol. 57 No. 4 (2025)

ISSN
2338-2732, 0125-9326
Terbit
2025-12-23
Penerbit
The Indonesian Society of Internal Medicine
Bahasa
eng
Lisensi
creativecommons.org/licenses/by/4.0

Abstrak

Background: Acute cholangitis is associated with high mortality, necessitating prompt diagnosis and intervention. The Tokyo Guidelines 2018 (TG18) are a crucial diagnostic tool, but their sensitivity and specificity require evaluation. Moreover, factors influencing acute cholangitis mortality in Indonesia remain unidentified. This study evaluates the diagnostic accuracy of TG18 and identifies mortality predictors in adult patients with acute cholangitis in Indonesia. Methods: A retrospective cohort study was conducted using the medical records of acute cholangitis patients at Cipto Mangunkusumo Hospital from 2019 to 2022. TG18 was compared with endoscopic retrograde cholangiopancreatography (ERCP). Bivariate and multivariate analyses were employed to identify mortality predictors. Results: The study involved 163 individuals (male: 51.5%; mean age: 51.0 ± 12.81 years). The in-hospital mortality rate was 11.6%. TG18 demonstrated a sensitivity and specificity of 84.05% (95% confidence interval (CI):77.51%–89.31%) and 95.65% (95%CI: 78.05%–99.89%), respectively, compared with ERCP. Significant mortality predictors in univariate analysis included TG18 grade III (risk ratio (RR): 13.85; 95%CI: 3.31–57.89; p<0.001), history of malignancy (RR: 4.40; 95%CI: 1.52–12.68; p=0.006), noncompliance with antibiotic guidelines (RR: 3.27; 95%CI: 1.36–7.85; p=0.008), and procalcitonin levels ≥ 2.0 ng/dL (RR: 2.44; 95%CI: 1.056–5.63; p=0.037). Multivariate analysis revealed that significant predictors included TG18 grade III (RR: 10.67; 95%CI: 2.50–45.56; p<0.001), non-compliance with antibiotic guidelines (RR: 2.92; 95%CI: 1.34–6.36; p=0.007), and procalcitonin levels ≥ 2.0 ng/dL (RR: 2.37; 95%CI: 1.18–4.75; p=0.015). Conclusion: TG18 demonstrates favorable sensitivity for diagnosing acute cholangitis. Independent predictors of acute cholangitis mortality include TG18 grade III, noncompliance with antibiotic guidelines, and procalcitonin levels ≥ 2.0 ng/dL.

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Rudi PutrantoAfiliasi tidak diketahui32
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Ikhwan RinaldiAfiliasi tidak diketahui18
Siti SetiatiAfiliasi tidak diketahui14
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Ari F SyamAfiliasi tidak diketahui6
Leonard NainggolanAfiliasi tidak diketahui6
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Khie Chen LieAfiliasi tidak diketahui5
Dono AntonoAfiliasi tidak diketahui5
Saskia Aziza NursyirwanAfiliasi tidak diketahui5
Irsan HasanAfiliasi tidak diketahui5
Tri Juli Edi TariganUniversity of Indonesia4
Mira YuliantiNational Research and Innovation Agency4
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Robert SintoAfiliasi tidak diketahui4
Adityo SusiloAfiliasi tidak diketahui4
Gurmeet SinghAfiliasi tidak diketahui4
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Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en-US">Performance of Tokyo Guidelines 2018 and Predictors of Mortality in Acute Cholangitis Patients in Indonesia</dc:title>
	<dc:creator>Yoga, Vesri</dc:creator>
	<dc:creator>Fauzi, Achmad</dc:creator>
	<dc:creator>Maulahela, Hasan</dc:creator>
	<dc:creator>Shatri, Hamzah</dc:creator>
	<dc:creator>Yunir, Em</dc:creator>
	<dc:creator>Waleleng, Bradley Jimmy</dc:creator>
	<dc:creator>Makmun, Dadang</dc:creator>
	<dc:creator>Renaldi, Kaka</dc:creator>
	<dc:creator>Rumende, Cleopas Martin</dc:creator>
	<dc:creator>Sukamto, Sukamto</dc:creator>
	<dc:subject xml:lang="en-US">acute cholangitis</dc:subject>
	<dc:subject xml:lang="en-US">Mortality</dc:subject>
	<dc:subject xml:lang="en-US">Tokyo guidelines 2018</dc:subject>
	<dc:description xml:lang="en-US">Background: Acute cholangitis is associated with high mortality, necessitating prompt diagnosis and intervention. The Tokyo Guidelines 2018 (TG18) are a crucial diagnostic tool, but their sensitivity and specificity require evaluation. Moreover, factors influencing acute cholangitis mortality in Indonesia remain unidentified. This study evaluates the diagnostic accuracy of TG18 and identifies mortality predictors in adult patients with acute cholangitis in Indonesia. Methods: A retrospective cohort study was conducted using the medical records of acute cholangitis patients at Cipto Mangunkusumo Hospital from 2019 to 2022. TG18 was compared with endoscopic retrograde cholangiopancreatography (ERCP). Bivariate and multivariate analyses were employed to identify mortality predictors. Results: The study involved 163 individuals (male: 51.5%; mean age: 51.0 ± 12.81 years). The in-hospital mortality rate was 11.6%. TG18 demonstrated a sensitivity and specificity of 84.05% (95% confidence interval (CI):77.51%–89.31%) and 95.65% (95%CI: 78.05%–99.89%), respectively, compared with ERCP. Significant mortality predictors in univariate analysis included TG18 grade III (risk ratio (RR): 13.85; 95%CI: 3.31–57.89; p&amp;lt;0.001), history of malignancy (RR: 4.40; 95%CI: 1.52–12.68; p=0.006), noncompliance with antibiotic guidelines (RR: 3.27; 95%CI: 1.36–7.85; p=0.008), and procalcitonin levels ≥ 2.0 ng/dL (RR: 2.44; 95%CI: 1.056–5.63; p=0.037). Multivariate analysis revealed that significant predictors included TG18 grade III (RR: 10.67; 95%CI: 2.50–45.56; p&amp;lt;0.001), non-compliance with antibiotic guidelines (RR: 2.92; 95%CI: 1.34–6.36; p=0.007), and procalcitonin levels ≥ 2.0 ng/dL (RR: 2.37; 95%CI: 1.18–4.75; p=0.015). Conclusion: TG18 demonstrates favorable sensitivity for diagnosing acute cholangitis. Independent predictors of acute cholangitis mortality include TG18 grade III, noncompliance with antibiotic guidelines, and procalcitonin levels ≥ 2.0 ng/dL.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2025-12-23</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/2831</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 57 No. 4 (2025): Acta Medica Indonesiana; 436</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/2831/826</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2025 Vesri Yoga, Achmad Fauzi, Hasan Maulahela, Hamzah Shatri, Em Yunir, Bradley Jimmy Waleleng, Dadang Makmun, Kaka Renaldi, Cleopas Martin Rumende, Sukamto Sukamto</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>