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).

Usage

This is for causes other than gall stones. At admission:

1. Age in years > 55 years
2. WBC count > 16000 cells/mm³
3. Blood glucose > 11.11 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

For acute pancreatitis secondary to gall stones.

At admission:

1. Glucose > 220mg/dl
2. Age > 70 years
3. LDH > 400IU/L
4. AST > 250IU/L
5. WBCs > 18000/ mm3

Within 48 hours:

1. S. Calcium < 8mg%
2. Hematocrit >10%
3. Base deficit > 4 mEq/L
4. BUN > 2mg%
5. Sequestrated fluid > 6L

Score of 3 or more indicates severe acute pancreatitis.

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

Alternatives

Alternatively, pancreatitis severity can be assessed by any of the following:

• 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