{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:46:12Z","timestamp":1768909572579,"version":"3.49.0"},"reference-count":14,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: It is not well understood whether the severity of acute cholecystitis (AC) correlates with the extent of gallbladder (GB) inflammation or laboratory findings. This study aimed to assess whether the severity of AC, in accordance with the Tokyo Guidelines (TGs), is consistent with the extent of GB inflammation on histopathological and laboratory findings, including microbiological isolation in blood and bile. Methods: The medical records of patients who underwent cholecystectomy for AC between January 2017 and May 2020 were reviewed. Demographic data, laboratory findings, the microbiologic culture of blood and bile, the extent of GB inflammation, and stone composition were compared in accordance with the TGs. Results: A total of 217 patients were divided into three groups of increasing severity\u2014Grade I (n = 146), Grade II (n = 51), and Grade III (n = 20)\u2014in accordance with the TGs. The Grade III group contained significantly older patients compared with the Grade I or Grade II groups (Grade I, 56.9 \u00b1 13.9; Grade II, 64.3 \u00b1 15.4; Grade III, 69.9 \u00b1 9.9; p-value &lt; 0.001). Patients in the Grade III group showed significantly higher levels of CRP, WBC, creatinine, and bilirubin and lower levels of platelets and albumin compared with the Grade I or Grade II group. As the grade of severity increased, the rate of microbiological isolation in blood (Grade I, 0% [0\/146]; Grade II, 2.0% [1\/51]; Grade III, 20% [4\/20]; p-value &lt; 0.001) and bile (Grade I, 19.9% [29\/146]; Grade II, 33.3% [17\/51]; Grade III, 70% [14\/20]; p-value &lt; 0.001) also increased significantly. However, there were no significant differences in the extent of GB inflammation between grades. Conclusions: AC severity, as stated by the TGs, does not correlate with the extent of GB inflammation on histopathological and laboratory findings. However, microbiological isolation in blood and bile was increased proportionally to the grade of the TGs.<\/jats:p>","DOI":"10.3390\/jpm13091335","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T09:44:46Z","timestamp":1693388686000},"page":"1335","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Relationship between the Tokyo Guidelines and Pathological Severity in Acute Cholecystitis"],"prefix":"10.3390","volume":"13","author":[{"given":"Tae Young","family":"Park","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Hyuk","family":"Do","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0068-5030","authenticated-orcid":false,"given":"Hyoung-Chul","family":"Oh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-0329","authenticated-orcid":false,"given":"Yoo Shin","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-9666","authenticated-orcid":false,"given":"Seung Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7902-4608","authenticated-orcid":false,"given":"Soon Auck","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Pathology, Chung-Ang University Hospital, Seoul 06973, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9610(05)80930-4","article-title":"Natural history of asymptomatic and symptomatic gallstones","volume":"165","author":"Friedman","year":"1993","journal-title":"Am. 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