A Simplified Physiology–Laboratory Score (PLS4) for Early Risk Stratification in Acute Cholangitis

Objectives

Acute cholangitis is a common biliary infection in the emergency department (ED) that can progress rapidly to septic shock and multiorgan dysfunction. The Tokyo Guidelines 2018 (TG2018) is the current reference standard for severity assessment but may be cumbersome during the initial ED encounter. We aimed to develop a simplified physiology–laboratory score (PLS4) computable from four routine bedside variables and to compare its early risk-stratification performance with TG2018. Materials and Methods: This single-center retrospective observational cohort study included 482 adult patients with acute cholangitis (International Classification of Diseases, 10th Revision code K83.0) presenting to a tertiary university hospital ED between January 2016 and December 2021. Primary outcomes were ICU admission, vasopressor use, and prolonged hospital stay (length of stay ≥ 14 days); intubation was analyzed as an exploratory outcome. PLS4 assigned 1 point each for albumin < 3.5 g/dL, systolic blood pressure ≤ 100 mmHg, heart rate ≥ 100/min, and prothrombin time–international normalized ratio ≥ 1.2 (range 0–4). Discrimination was assessed by receiver operating characteristic curves, with bootstrap 95% confidence intervals and bootstrap optimism-corrected internal validation.