What are the Ranson criteria for prognosis in acute pancreatitis?

Ranson criteria: 

Ranson criteria or scoring system is designed for assessing the severity of acute pancreatitis. Some of the parameters are considered at admission while other groups of parameters are added to the scoring system that is developed in the first 48 hours.

The parameters at admission:

  • Age over 55 years
  • White blood cell count > 16 × 103/mcL (> 16 × 109/L)
  • Blood glucose > 200 mg/dL (> 11 mmol/L)
  • Serum lactic dehydrogenase > 350 units/L (> 7 mkat/L)
  • Aspartate aminotransferase > 250 units/L (> 5 mkat/L)

The parameters that are developed in the first 48 hours:

  • Hematocrit drop of more than 10 percentage points
  • Blood urea nitrogen rise > 5 mg/dL (> 1.8 mmol/L)
  • Arterial PaO2 of < 60 mm Hg (< 8 kPa)
  • Serum calcium of < 8 mg/dL (< 2 mmol/L)
  • Base deficit over 4 mEq/L
  • Estimated fluid sequestration of > 6 L

Interpretation:

  • Three or more of the above-mentioned criteria predict a severe course of acute pancreatitis complicated by pancreatic necrosis with a sensitivity of 60–80%.
  • Development of the second group of parameters in the first 48 hours indicates a worsening prognosis.
  • Mortality rates correlate with the number of criteria or parameters present (at the table below). 
Ranson criteria or score

Source:

  • CURRENT Medical Diagnosis & Treatment 2018; page: 739; Table: 16-9
  • Step Up to MRCP Review Note for Part I & Part II by Dr Khaled El Magraby; page: 294

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