Medicine:Ranson criteria
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| Ranson criteria | |
|---|---|
| Medical diagnostics | |
| Purpose | assess mortality risk of acute pancreatitis |
The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis. They were introduced in 1974 by the England -United States pancreatic expert and surgeon Dr. John Ranson (1938–1995).[1]
Usage
A score of 3 or more indicates severe acute pancreatitis. This can cause organ failure, necrosis, infected necrosis, pseudocyst, and abscess. If diagnosed with severe acute pancreatitis, people will need to be admitted to a high-dependency unit or intensive care unit.
Acute pancreatitis not secondary to gallstones
At admission:
- Blood glucose > 11.11 mmol/L (> 200 mg/dL)
- Age > 55 years
- Serum LDH > 350 IU/L
- Serum AST > 250 IU/L
- WBC count > 16000 cells/mm3
Within 48 hours:
- Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
- Hematocrit decreased by > 10%
- Oxygen (hypoxemia with PaO2 < 60 mmHg)
- BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
- Base deficit (negative base excess) > 4 mEq/L
- Sequestration of fluids > 6 L
Acute pancreatitis secondary to gallstones
At admission:
- Glucose > 220 mg/dl
- Age > 70 years
- LDH > 400 IU/L
- AST > 250 IU/ 100 ml
- WBC count > 18000 cells/mm3
Within 48 hours:
- Serum calcium < 8 mg/dL
- Hematocrit decreased by > 10%
- Base deficit > 4 mEq/L
- BUN increased by > 2 mg/dL
- Sequestered fluid > 6L
Alternatives
Alternatively, pancreatitis severity can be assessed by any of the following:[2]
- APACHE II score ≥ 8
- Balthazar computed tomography severity index (CTSI)
- BISAP score
- Organ failure
- Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CT)
- Modified Glasgow Criteria
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
- ↑ "Prognostic signs and the role of operative management in acute pancreatitis". Surgery, Gynecology & Obstetrics 139 (1): 69–81. 1974. PMID 4834279.
- ↑ Baron, Todd H.; Desiree E. Morgan (1999-05-06). "Acute Necrotizing Pancreatitis". N Engl J Med 340 (18): 1412–1417. doi:10.1056/NEJM199905063401807. PMID 10228193. http://content.nejm.org/cgi/content/full/340/18/1412. Retrieved 2009-02-08.
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