Acute Cholangitis in PSC — Tokyo vs Wannhoff

Score the Tokyo (TG18) and Wannhoff criteria side by side on the same patient — both must be entered — and see where they disagree.

Adults with primary sclerosing cholangitis being assessed for acute bacterial cholangitis. Neither criteria set is validated in PSC and the International PSC Study Group reached no consensus on a definition, so this tool reports BOTH and highlights disagreement rather than issuing one verdict. Do not enter protected health information.

Caveats

There is no agreed definition in PSC

The International PSC Study Group could not agree on a definition of acute bacterial cholangitis in PSC. This tool therefore scores both published systems and shows where they disagree; it does not pick one, because the field has not.

“The panel was unable to reach consensus through the Delphi process on the definition of acute bacterial cholangitis in the context of PSC. This highlights an urgent, unmet need for dedicated studies comparing Tokyo, Wannhoff (see Supplementary Material), and other potential criteria so that a uniform approach can be used as a clinical endpoint in therapeutic trials.”

Defining Primary Sclerosing Cholangitis: Results From an International Primary Sclerosing Cholangitis Study Group Consensus Process. · 2021 · PMID 34384749

Tokyo is of limited utility in PSC

Tokyo's cholestasis and imaging items are frequently abnormal at baseline in PSC, so TG18 can read positive on chronic disease alone. Weigh the Tokyo result against the patient's own baseline, not against a healthy reference.

“is of limited utility in the setting of PSC because many patients already have abnormal liver test results and imaging at baseline.”

Defining Primary Sclerosing Cholangitis: Results From an International Primary Sclerosing Cholangitis Study Group Consensus Process. · 2021 · PMID 34384749

Wannhoff is not validated

SECOND-HAND. This is the ISG consensus paper's description of the Wannhoff criteria, quoted verbatim -- not the primary source. The criteria were defined in the methods of Wannhoff et al., Clin Gastroenterol Hepatol 2015 (PMID 26192140), a study of CA19-9 whose title does not mention them; that paper is not in this corpus. The ISG states the system has not been studied in larger PSC populations and is not validated for use.

“has not yet been studied in larger PSC populations and is currently not validated for use.”

Defining Primary Sclerosing Cholangitis: Results From an International Primary Sclerosing Cholangitis Study Group Consensus Process. · 2021 · PMID 34384749