Severe cholecystitis (Grade 3) - one or more organ dysfunctions:
(1) cardiovascular (hypotension requiring pressor therapy)
(2) neurological (decreased level of consciousness)
(3) respiratory (PaO2 to FIO2 ratio < 300)
(4) renal (oliguria or serum creatinine > 2.0 mg/dL)
(5) hepatic (INR > 1.5 not due to anticoagulants)
(6) hematologic (platelet count < 100,000 per µL)
where:
• Pressor therapy is any dose of dobutamine OR dopamine >= 5 µg/kg per minute OR equivalent.
Moderate cholecystitis (Grade 2) - NOT Grade 3 AND one or more of the following:
(1) leukocytosis > 18,000 per µL
(2) palpable and tender mass in the right upper quadrant (RUQ)
(3) duration of attack > 72 hours
(4) marked local inflammation - one or more of the following
(4a) biliary peritonitis
(4b) pericholecystic abscess
(4c) hepatic abscess
(4d) gangrenous cholecystitis
(4e) emphysematous cholecystitis
Mild cholecystitis (Grade 1) - acute cholecystitis NOT Grade 2 or 3
In mild cholecystitis the patient is healthy without organ dysfunction and only mild inflammatory changes in the gallbladder.
