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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
Published
2025-12-23
Publisher
The Indonesian Society of Internal Medicine
Language
eng
License
creativecommons.org/licenses/by/4.0

Abstract

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.

Keywords

Collaboration network of the authors

40 authors · 326 co-authorship links · showing the 40 most connected

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  • University of Indonesia
  • Affiliation unknown
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Co-authorOrganisationJoint articles
Rudi PutrantoAffiliation unknown32
Murdani AbdullahAffiliation unknown19
Ikhwan RinaldiAffiliation unknown18
Siti SetiatiAffiliation unknown14
Ari Fahrial SyamAffiliation unknown12
Marcellus SimadibrataAffiliation unknown12
Edward FaisalAffiliation unknown11
Imam SubektiAffiliation unknown10
Iris RengganisAffiliation unknown7
Pringgodigdo NugrohoAffiliation unknown7
Juferdy KurniawanAffiliation unknown7
Idrus AlwiAffiliation unknown6
Sally Aman NasutionAffiliation unknown6
Kuntjoro HarimurtiAffiliation unknown6
Ari F SyamAffiliation unknown6
Leonard NainggolanAffiliation unknown6
Cosphiadi IrawanAffiliation unknown5
Khie Chen LieAffiliation unknown5
Dono AntonoAffiliation unknown5
Saskia Aziza NursyirwanAffiliation unknown5
Irsan HasanAffiliation unknown5
Tri Juli Edi TariganUniversity of Indonesia4
Mira YuliantiAffiliation unknown4
Alvina WidhaniAffiliation unknown4
Robert SintoAffiliation unknown4
Adityo SusiloAffiliation unknown4
Gurmeet SinghAffiliation unknown4
Dyah PurnamasariAffiliation unknown4
Pradana SoewondoAffiliation unknown3
Cleopas M RumendeAffiliation unknown3

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, first harvested 8 Nov 2026, last seen 8 Nov 2026.
Original metadata (oai_dc) 
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	<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>