Ranson Criteria for Acute Pancreatitis Severity

Ranson criteria are one of the earliest validated prognostic systems for acute pancreatitis. At admission the five criteria are age over 55 years, white blood cell count above 16,000/mm3, blood glucose above 200 mg/dL, LDH above 350 IU/L and AST above 250 IU/L. At 48 hours the six criteria are hematocrit fall of at least 10 percentage points, BUN rise of at least 5 mg/dL despite fluids, serum calcium below 8 mg/dL, PaO2 below 60 mmHg, base deficit above 4 mEq/L and estimated fluid sequestration above 6 L. Each criterion contributes one point; a total of 3 or more predicts severe pancreatitis. Mortality in the original series was about 0-3% with fewer than 3 criteria, 11-15% with 3-5, and around 40% or more with 6 or more. The classic non-gallstone criteria are implemented; a modified set exists for gallstone pancreatitis (age over 70, WBC over 18,000, glucose over 220, LDH over 400 at admission; hematocrit fall over 10%, BUN rise over 2, calcium below 8, base deficit over 5, fluid sequestration over 4 L at 48 hours). The score requires 48-hour data for a final grade; an admission-only partial score is reported when the later fields are pending. The score complements rather than replaces imaging severity assessment (revised Atlanta, CT severity index).