Ranson criteria

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]

Ranson criteria
Purposeassess mortality risk of acute pancreatitis

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.

The mnemonic "GALAW & CHOBBS" (Glucose, Age, LDH, AST, WBCs; Calcium, Hematocrit, Oxygen, BUN, Base, Sequestered fluid) can be used to help remember these criteria.

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)

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

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