Ranson Criteria to Predict Severity of Acute Pancreatitis

 

1. When three or more of the following are present on admission, a severe course complicated by pancreatic necrosis can be predicted with a sensitivity of 60-80%:

• Age over 55 years.

• White blood cell count over 16,000/uL.

• Blood glucose over 200 mg/dL.

• Serum lactate dehydrogenase (LDH) over 350 units/L.

• Aspartate aminotransferase (AST, SGOT) over 250 units/L.

2. Development of the following in the first 48 hours indicates a worsening prognosis:

• Hematocrit drop of more than ten percentage points.

• Blood urea nitrogen (BUN) rise greater than 5 mg/dL.

• Arterial PO2 of less than 60 mm Hg.

• Serum calcium of less than 8 mg/dL.

• Base deficit over 4 meq/L.

• Estimated fluid sequestration of more than 6 L.

3. Mortality rates correlate with the number of criteria present:

 

  

 

Balthazar CT severity index for acute pancreatitis.

 

CT Grade	Points	Necrosis (%)	Additional Points	Severity Index	Mortality Rate (%)
A Normal pancreas	0	0	0	0	0
B Pancreatic enlargement	1	0	0	1	0
C Pancreatic inflammation and/or peripancreatic fat	2	< 30	2	4	0
D Single peripancreatic fluid collection	3	30-50	4	7	> 17
E Two or more fluid collections or retroperitoneal air	4	> 50	6	10

 

References:

1. Ranson JH. Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol. 1984 Sep;13(3):843-63. [Medline]

2. Balthazar EJ: Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002;223:603. [Medline]