Ranson criteria

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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. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  2. ↑ http://bestpractice.bmj.com/best-practice/monograph/66/diagnosis/criteria.html
  3. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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