Ranson criteria in acute pancreatitis

The initial clinical picture is not a reliable indicator of future events in mild pancreatitis. Patients with seemingly mild disease may deteriorate rapidly and die.

The Ranson criteria and other severity scoring systems, e.g. Glasgow, APACHE II, enable early diagnosis of severe acute pancreatitis. This can be defined as the presence of three or more of the following criteria within 48 hours of admission:

• age above than 55 years
• blood glucose above 10 mmol/L - no history of diabetes
• white cell count above 15 x 10^9 / L
• LDH above 600 IU/L
• aspartate transaminase above 200 u/L
• corrected calcium less than 2.0 mmol/L
• blood urea above 16 mmol/L - no improvement with intravenous fluids
• decreasing haematocrit
• arterial pO2 less than 8 kPa (60 mm Hg)
• metabolic acidosis
• serum albumin less than 32 g/L

N.B. the serum amylase value is not one of the criteria.

The mortality per postive criterion:

• NUMBER OF POSITIVE CRITERIA
  • 0-2 <5% mortality
  • 3-4 20% mortality
  • 5-6 40% mortality
  • 7-8 100% mortality