Parameters:
(1) serum creatinine
(2) serum total bilirubin (part of Charcot's triad)
(3) bile duct stricture
(4) biliary tract stones
|
Parameter
|
Finding
|
Points
|
|
serum creatinine
|
< 1.5 mg/dL
|
0
|
|
|
>= 1.5 mg/dL
|
1
|
|
serum total bilirubin
|
not elevated
|
0
|
|
|
elevated
|
1
|
|
stones
|
in both the common and intrahepatic bile ducts
|
1
|
|
|
not in both
|
0
|
|
bile duct stricture
|
absent
|
0
|
|
|
present
|
1
|
where:
• The type of stricture is not specified. Some of the previous scores mentioned malignant strictures as a risk factor.
• The level for an elevated bilirubin was not specified. One approach is to use clinical jaundice. Another is to use a cutoff like > 5.3 or > 5.4.
total number of risk factors associated with mortality =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
Mortality based on clinical pattern:
(1) Reynold's pentad (Charcot's triad + hypotension + altered mental status): 21%
(2) Charcot's triad (fever + jaundice + RUQ tenderness) alone: 8%
(3) neither: 1%
Risk factors for an elevated serum creatinine:
(1) advanced age
(2) low serum albumin
(3) delay in biliary tract drainage
(4) clinical deterioration with multi-organ failure
