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Updated: Feb 10, 2026

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Risk Stratification and Validation of ICU Scores in Prediction of Post-ERCP Mortality for Critically Ill Patients

Esam Elshimi1, Tamer Refaat Fouad1, Wael M Abdel-Razek1

  • 1Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University.

Journal of Clinical Gastroenterology
|February 9, 2026
PubMed

Insights

The SOFA score effectively predicts intensive care unit mortality in severe acute cholangitis (SAC) patients, offering valuable insights beyond the Tokyo Guidelines 2018. This study validates its use for improved patient outcomes.

Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Gastroenterology

Background:

  • Severe acute cholangitis (SAC) mortality prediction lacks systematic validation of existing scoring systems like SOFA, APACHE II, and SAPS II against the Tokyo Guidelines 2018.
  • This study addresses the need to evaluate the efficacy of these established scores in predicting mortality within the SAC patient cohort.

Purpose of the Study:

  • To assess the predictive value of SOFA, APACHE II, and SAPS II scores for mortality in patients diagnosed with severe acute cholangitis (SAC) based on the Tokyo Guidelines 2018.
  • To determine if these scoring systems can be reliably used to identify high-risk SAC patients.

Main Methods:

  • A prospective observational study involving 175 SAC patients (Tokyo Guidelines 2018) undergoing ERCP between January 2022 and May 2023.
  • Calculation and comparison of SOFA, APACHE II, and SAPS II scores to evaluate their correlation with intensive care unit (ICU) mortality.

Main Results:

  • ICU mortality rate was 18.9% (33/175 patients).
  • SOFA, APACHE II, and SAPS II scores were significantly higher in non-survivors (P=0.001, P=0.011, P=0.021 respectively).
  • Only the SOFA score independently predicted ICU mortality (aOR: 1.241; 95% CI: 1.09-4.1) with an AUC of 0.89.

Conclusions:

  • SOFA, APACHE II, and SAPS II scores are valuable tools for predicting mortality in severe acute cholangitis.
  • The SOFA score demonstrates the strongest independent predictive capability for ICU mortality in SAC patients.
  • These validated scores can augment the prognostic information provided by the Tokyo Guidelines 2018 for SAC management.
Abstract

Keywords:
APACHE IIERCPSAPS IISOFATokyo guidelines 2018cholangitis

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