Abstract Background: Community-acquired acute cholangitis (CAAC) can progress to acute organ injury (AOI), increasing poor prognosis risk. This study aimed to develop machine learning models using clinical information obtained before AOI onset to predict new-onset AOI within 48 h after admission in patients with CAAC. Methods: This single-center retrospective cohort study screened 487 patients with CAAC between January 2018 and December 2022; 456 without AOI at admission were included.