Validation of charcot's triad and Tokyo guidelines 2018 as a diagnostic tool for acute ascending cholangitis secondary to a liver cystic echinococcosis.

Introduction: This study aimed to evaluate the diagnostic accuracy of Charcot's triad (CT) and the Tokyo Guidelines 2018 (TG18) for acute ascending cholangitis (AAC) secondary to liver cystic echinococcosis (LEC) rupture in the biliary tree.

Methods: This retrospective multicenter study was conducted between January 2016 and December 2021. The diagnostic performance of CT and TG18 was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve.

Results: Among 1643 patients, 133 were diagnosed with AAC (8.1%). Concerning CT, the analytical study showed that the incomplete form had a sensitivity of 28.6%, specificity of 91.9%, PPV of 36%, and NPV of 89%. The complete form had a sensitivity, specificity, PPV, and NPV of 25.4%, 97.5%, 61.5%, and 89.1%, respectively. For TG18, the suspected/definite form had a sensitivity, specificity, PPV, and NPV of 74.6%, 68.2%, 22.1%, and 93.5%, respectively. The definite form had a sensitivity, specificity, PPV, and NPV of 65.1%, 88.4%, 47.1%, and 94.1%, respectively. The Suspected form was estimated at an AUC of 0.447, with a non-significant p-value.

Conclusions: This research emphasizes the complexity of AAC diagnosis and the limitations of current diagnostic tools. TG18, especially in its definite form, can effectively rule out AAC, whereas CT, despite its low sensitivity, remains useful due to its high specificity. The findings advocate further research to refine the existing diagnostic methods and develop new tools.