Ranson Criteria For Pancreatitis

Ranson criteria explained

The Ranson pancreatitis criteria assesses mortality risk based on clinical and laboratory determinations which are available at time of admission and after 48h.

The calculator above is based on the original model published by Ranson in 1974. John H. C. Ranson was the director of the division of general surgery at the NYU. His research was revolutionary in the field of pancreatic disease.

The factors evaluated at admission are:

■ Patient age: where patients over 55 are considered to have a higher mortality risk;

■ White blood cell count (WBC): as sign of inflammation, along fever;

■ Blood glucose level: increased levels due to altered pancreas function (insulin production);

■ Serum aspartate aminotransferase (AST): increased AST levels indicate pancreas inflammation;

■ Serum lactate dehydrogenase (LDH): gallbladder pancreatitis, the LDH to AST ratio is increased.

The factors evaluated 48 hours into admission:

■ Hematocrit fall: hemoconcentration indicates pancreas necrosis;

■ Arterial oxygen pressure: as indication of respiratory function;

■ Blood urea nitrogen (BUN): is an early marker in AP assessment;

■ Serum calcium: determination of serum ionized calcium;

■ Base deficit: as predictor of AP mortality risk alongside arterial pH and bicarbonate levels;

■ Sequestration of fluid: sign of hemodynamic impairment, hypovolemia.

The table below compares the Ranson criteria for non gallstone and gallstone pancreatitis:

Result interpretation

Each of the 11 criteria can or not be present at admission, respectively after 48 hours.

Each positive occurrence counts as 1 towards the final score. The following table correlates the Ranson score with the predicted mortality percentage:

Medical implications of pancreatitis

Acute pancreatitis represents the inflammation of the pancreas in cases where there is no CT or endoscopic proof of a chronic pancreatic condition. This is a condition more common in middle aged and elderly persons.

The two most occurring forms are alcoholic (more common in men) and gallstone pancreatitis.

Acute necrotizing pancreatitis is the severe inflammation presenting with necrosis in different stages. It leads to impaired function, malabsorption, insulin deficiency and diabetes mellitus.

Characteristic presentation is abdominal pain, high serum amylase or lipase and CT scan findings.

Acute episodes can be managed, inflammation is overcome and function is re-established. Complications can lead, however, to multiple organ failure and prove fatal.

Original source

Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.

Other references

1. Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010; 105(2):435-41.

2. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974; 61(6):443-51.