Ranson criteria

The Ranson criteria form a clinical prediction rule for predicting the severity of acute pancreatitis. They were introduced in 1974.^[1]

Usage

For non-gallstone pancreatitis, the parameters are:

At admission:

1. Age in years > 55 years
2. WBC count > 16000 cells/mm³
3. Blood glucose > 11 mmol/L (> 200 mg/dL)
4. Serum AST > 250 IU/L
5. Serum LDH > 350 IU/L

Within 48 hours:

1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit fall > 10%
3. Oxygen (hypoxemia 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

The criterion for point assignment is that a certain breakpoint be met at any time during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to non-gallstone pancreatitis.

The mnemonic GALAW AND CHOBBS can be used to remember this criteria. Stands for Glucose, Age, LDH, AST and WBC; Calcium, Hematocrit, Oxygen, BUN, Base, Sequestration.

For gallstone pancreatitis, the parameters are:^[2]

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

Within 48 hours:

1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit fall > 10%
3. Oxygen (hypoxemia PaO₂ < 60 mmHg)
4. BUN increased by 0.7 or more mmol/L (2 or more mg/dL) after IV fluid hydration
5. Base deficit (negative base excess) > 5 mEq/L
6. Sequestration of fluids > 4 L

Alternatives

Alternatively, pancreatitis severity can be assessed by any of the following:^[3]

• APACHE II score ≥ 8
• 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. http://bestpractice.bmj.com/best-practice/monograph/66/diagnosis/criteria.html
3. 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.