Ranson criteria explained

Ranson criteria
Purpose:	assess mortality risk of acute pancreatitis

The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis. They were introduced in 1974 by the English-American pancreatic expert and surgeon Dr. John Ranson (1938–1995).^[1]

Usage

A score of 3 or more indicates severe acute pancreatitis. This can cause organ failure, necrosis, infected necrosis, pseudocyst, and abscess. If diagnosed with severe acute pancreatitis, people will need to be admitted to a high-dependency unit or intensive care unit.

Acute pancreatitis not secondary to gallstones

At admission:

1. Blood glucose > 11.11 mmol/L (> 200 mg/dL)
2. Age > 55 years
3. Serum LDH > 350 IU/L
4. Serum AST > 250 IU/L
5. WBC count > 16000 cells/mm³

Within 48 hours:

1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit decreased by > 10%
3. Oxygen (hypoxemia with PaO₂ < 60 mmHg)
4. BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
5. Base deficit (negative base excess) > 4 mEq/L
6. Sequestration of fluids > 6 L

Acute pancreatitis secondary to gallstones

At admission:

1. Glucose > 220 mg/dl
2. Age > 70 years
3. LDH > 400 IU/L
4. AST > 250 IU/ 100 ml
5. WBC count > 18000 cells/mm³

Within 48 hours:

1. Serum calcium < 8 mg/dL
2. Hematocrit decreased by > 10%
3. Base deficit > 4 mEq/L
4. BUN increased by > 2 mg/dL
5. Sequestered fluid > 6L

Alternatives

Alternatively, pancreatitis severity can be assessed by any of the following:^[2]

• APACHE II score ≥ 8

• Balthazar computed tomography severity index (CTSI)

• BISAP score

• Organ failure

• Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CT)

• Modified Glasgow Criteria

Interpretation

• If the score ≥ 3, severe pancreatitis likely.
• If the score < 3, severe pancreatitis is unlikely

Or

• Score 0 to 2 : 2% mortality
• Score 3 to 4 : 15% mortality
• Score 5 to 6 : 40% mortality
• Score 7 to 8 : 100% mortality

Notes and References

1. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC . Prognostic signs and the role of operative management in acute pancreatitis . Surgery, Gynecology & Obstetrics . 139 . 1 . 69–81 . 1974 . 4834279 .
2. 10.1056/NEJM199905063401807. 340. 18. 1412–1417. Baron. Todd H.. Desiree E. Morgan . Acute Necrotizing Pancreatitis. N Engl J Med. 2009-02-08. 1999-05-06. 10228193.