Ranson criteria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Ranson criteria is a clinical prediction rule for predicting the severity of acute pancreatitis.

History

It was introduced in 1974.

Usage

Parameters used:

At admission:

1. age in years >55years
2. white blood cell count > 16000/mcL
3. blood glucose > 11 mmol/L (>200 mg/dL)
4. serum AST > 250 IU/L
5. serum LDH > 350 IU/L

After 48 hours:

1. Haematocrit fall > 10%
2. increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
3. hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
4. hypoxemia (P_O2 < 60 mmHg)
5. Base deficit > 4Meq/L
6. Estimated fluid sequestration > 6L

The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.

For gallstone pancreatitis:

At admission:

1. age in years > 70 years
2. white blood cell count > 18000 cells/mm³
3. blood glucose > 12.2 mmol/L (> 220 mg/dL)
4. serum AST > 250 IU/L
5. serum LDH > 400 IU/L

At 48 hours:

1. Hematocrit fall > 10%
2. Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
3. Oxygen (hypoxemia P_O2 < 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) > 5 mEq/L
6. Sequestration of fluids > 4 L

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