Ranson Criteria For Pancreatitis

Predicts mortality risk of patients suffering from acute pancreatitis, at admission and after 48h.

You can read more about the clinical prediction rule used and about the result interpretation in the text below the calculator.


The Ranson criteria calculator predicts risk of adverse outcome in patients presenting with acute pancreatitis.

There are two types of pancreatitis criteria, 5 to be assessed at admission and 6 to be assessed 48 hours into admission.

Quick management of acute pancreatitis can reduce hospital stay and risk of complications.


Each positive occurrence of the criteria in the model is awarded 1 point.

Therefore, the more risk factors for adverse outcome, the higher the score and the mortality risk.

The table below introduces the mortality risk percentages correlated with each possible score.

Points Predicted mortality
0 1%
1, 2 2%
3, 4 15%
5, 6 40%
7 - 11 100%

A

At the time of admission:

1

White blood cell count higher than 16,000?

2

Age higher than 55?

3

Blood glucose more than 200 mg/dL (10 mmol/L)?

4

Aspartate aminotransferase (AST) more than 250?

5

Lactate dehydrogenase (LDH) more than 350?

B

48 hours into admission:

6

Hematocrit fall more than 10% from admission?

7

Arterial oxygen pressure less than 60 mmHg (hypoxemia)?

8

Blood urea nitrogen (BUN) increase higher than 5 mg/dL (1.8 mmol/L)?

9

Serum calcium less than 8 mg/dL (2 mmol/L)?

10

Base deficit (measured HCO3 to 24) more than 4 mEq/L?

11

Sequestration of fluids more than 6L?

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

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:

Criteria Non gallstone pancreatitis Gallstone pancreatitis
At admission
Age >55 >70
WBC >16,000 >18,000
Glucose >200 mg/dL >220 mg/dL
Serum AST >250 >250
Serum LDH >350 >400
Within 48 hours
Hematocrit fall >10% >10%
Oxygen <60 mmHg <60 mmHg
BUN increase >5 mg/dL >2 mg/dL
Calcium <8 mg/dL <8 mg/dL
Base deficit >4 mEq/L >5 mEq/L
Fluid sequestration >6 L >4 L
 

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:

Points Predicted mortality
0 1%
1, 2 2%
3, 4 15%
5, 6 40%
7 - 11 100%
 

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.


App Version: 1.0.1

Coded By: MDApp

Specialty: Gastroenterology

System: Digestive

Objective: Mortality Risk Predictor

Type: Criteria

No. Of Criteria: 11

Year Of Study: 1974

Article By: Denise Nedea

Published On: April 13, 2017 · 07:52 AM

Last Checked: April 13, 2017

Next Review: April 13, 2018