Ranson criteria

The Ranson criteria form a clinical prediction rule for predicting the severity of acute pancreatitis. They were introduced in 1974.^[1]

Usage

Parameters used:

At admission:

1. Age in years > 55 years
2. White blood cell count > 16000 cells/mm³
3. Blood glucose > 10 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 P_O2 < 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

The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to non-gallstone pancreatitis. For gallstone pancreatitis, the parameters are:

At admission:

1. Age in years > 70 years
2. White blood cell count > 18000 cells/mm³
3. Blood glucose > 12.2 mmol/L (> 220 mg/dL)
4. Serum AST > 250 IU/L
5. Serum LDH > 400 IU/L

Within 48 hours:

1. Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit fall > 10%
3. Oxygen (hypoxemia P_O2 < 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) > 5 mEq/L
6. Sequestration of fluids > 4 L

This can be remembered by the mnemonic "WALLS FOr CHUB" (think of the ice cream brand and the stereotypical patient).

At admission:

W = WBC

A = Age

L = LDH

L = Liver enzyme (AST)

S = Sugar

After 48hrs:

F = Fluid requirement

O = pA02

C = Calcium

H = Haematocrit

U = Urea

B = Base deficit

This can also be remembered by the pneumonic "GA LAW" for the on admission parameters and "C HOBBS" (as in Calvin and Hobbes) for the 48 hour parameters.

Alternatively, pancreatitis severity can be assessed by any of the following:^[2]

• APACHE II score ≥ 8
• 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..

References