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Table 1 Severity classification of acute cholecystitis by the Tokyo guidelines 2013

From: Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis

Grade Definition
I (Mild) Acute cholecystitis that does not meet the criteria for grade III or grade II cholecystitis
Acute cholecystitis in a healthy patient with no organ dysfunction. Inflammatory changes in the gallbladder are mild, making cholecystectomy a safe and low-risk procedure.
II (Moderate) Grade II acute cholecystitis is 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, and emphysematous cholecystitis)
III (Severe) Grade III acute cholecystitis associated with dysfunction of any one of the following organs/systems
1 Cardiovascular dysfunction defined as hypotension requiring treatment with dopamine  ≥  5 μg/kg per min or any dose of norepinephrine
2 Neurologic dysfunction defined as decreased level of consciousness
3 Respiratory dysfunction defined as a PaO2/FiO2 ratio  <  300
4 Renal dysfunction defined as oliguria or creatinine  >  2.0 mg/dl
5 Hepatic dysfunction defined as PT-INR  >  1.5
6 Hematologic dysfunction defined as platelet count  <  100,000/mm3