• Erdinc Gulumsek, Fatih Yesildal, Ismail Yigitdol, İbrahim Erdem, Huseyin Can Arbag, Akkan Avci, Tayyibe Saler, Banu Kara, Adnan Tas, and Hilmi Erdem Sumbul.
• Department of Gastroenterology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
• Ir J Med Sci. 2022 Jun 1; 191 (3): 1177-1183.

BackgroundTokyo guidelines (TG13/18) are used for the severity assessment of acute cholangitis (AC). Lactate is a clinical marker of tissue hypoxia and disease severity, independent from blood pressure.AimThe aim of this study is to investigate the relationship between blood lactate level and TG13/18 criteria in patients diagnosed with AC.MethodsOne hundred fifteen patients with AC were included in this retrospective study. Demographic characteristics of the patients and laboratory data were scanned from their hospital medical records. According to TG13/18 guidelines, the patients were divided into 3 groups as mild (grade 1), moderate (grade 2), and severe (grade 3) AC.ResultsSixty three (54.7%) of the patients were grade 1, 37 (32.1%) were grade 2, and 15 (13.0%) were grade 3. It was found that blood lactate level increased significantly from grade 1 to grade 3 (p < 0.001). In logistic regression analysis, white blood cell (WBC) count, total bilirubin and blood lactate levels independently determined the patients to be grade 2 or 3 AC. When the blood lactate cut-off value was taken as 16.5 mg/dL, we diagnosed grade 2 or 3 AC with a sensitivity of 78.8% and a specificity of 75.7%. From among lactate, WBC, and C reactive protein, lactate showed the highest value regarding the area under the curve, which is an index for predicting grade III upon ROC analysis.ConclusionThe blood lactate level is associated with the severity of AC. In addition to TG13/18 guidelines, blood lactate level can be a useful biomarker in the severity grading of AC.© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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