Ranson criteria
Encyclopedia
Ranson criteria is a clinical prediction rule
for predicting the severity of acute pancreatitis
. It was introduced in 1974.
At admission:
At 48 hours:
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:
At 48 hours:
Alternatively, pancreatitis severity can be assessed by any of the following:
Or
Clinical prediction rule
A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome....
for predicting the severity of acute pancreatitis
Acute pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment...
. It was introduced in 1974.
Usage
Parameters used:At admission:
- age in years > 55 years
- white blood cellWhite blood cellWhite blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
count > 16000 cells/mm3 - blood glucose > 10 mmol/L (> 200 mg/dL)
- serum ASTAspartate transaminaseAspartate transaminase , also called aspartate aminotransferase or serum glutamic oxaloacetic transaminase , is a pyridoxal phosphate -dependent transaminase enzyme . AST catalyzes the reversible transfer of an α-amino group between aspartate and glutamate and, as such, is an important enzyme in...
> 250 IU/L - serum LDHLactate dehydrogenaseLactate dehydrogenase is an enzyme present in a wide variety of organisms, including plants and animals.Lactate dehydrogenases exist in four distinct enzyme classes. Two of them are cytochrome c-dependent enzymes, each acting on either D-lactate or L-lactate...
> 350 IU/L
At 48 hours:
- Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
- HematocritHematocritThe hematocrit or packed cell volume or erythrocyte volume fraction is the percentage of the concentration of red blood cells in blood. It is normally about 45% for men and 40% for women...
fall > 10% - Oxygen (hypoxemiaHypoxemiaHypoxemia is generally defined as decreased partial pressure of oxygen in blood, sometimes specifically as less than or causing hemoglobin oxygen saturation of less than 90%.-Distinction from anemia and hypoxia:...
PO2 < 60 mmHg) - BUNBunA bun is a small, usually sweet, bread. Commonly they are hand-sized or smaller, domed in shape, with a flat bottom. A bun can also be a savory bread roll similar to a bap or barmcake....
increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration - Base deficit (negative base excessBase excessIn human physiology, base excess and base deficit refer to an excess or deficit, respectively, in the amount of base present in the blood. The value is usually reported as a concentration in units of mEq/L, with positive numbers indicating an excess of base and negative a deficit...
) > 4 mEq/L - 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:
- age in years > 70 years
- white blood cellWhite blood cellWhite blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
count > 18000 cells/mm3 - blood glucose > 12.2 mmol/L (> 220 mg/dL)
- serum ASTAspartate transaminaseAspartate transaminase , also called aspartate aminotransferase or serum glutamic oxaloacetic transaminase , is a pyridoxal phosphate -dependent transaminase enzyme . AST catalyzes the reversible transfer of an α-amino group between aspartate and glutamate and, as such, is an important enzyme in...
> 250 IU/L - serum LDHLactate dehydrogenaseLactate dehydrogenase is an enzyme present in a wide variety of organisms, including plants and animals.Lactate dehydrogenases exist in four distinct enzyme classes. Two of them are cytochrome c-dependent enzymes, each acting on either D-lactate or L-lactate...
> 400 IU/L
At 48 hours:
- Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
- HematocritHematocritThe hematocrit or packed cell volume or erythrocyte volume fraction is the percentage of the concentration of red blood cells in blood. It is normally about 45% for men and 40% for women...
fall > 10% - Oxygen (hypoxemiaHypoxemiaHypoxemia is generally defined as decreased partial pressure of oxygen in blood, sometimes specifically as less than or causing hemoglobin oxygen saturation of less than 90%.-Distinction from anemia and hypoxia:...
PO2 < 60 mmHg) - BUNBunA bun is a small, usually sweet, bread. Commonly they are hand-sized or smaller, domed in shape, with a flat bottom. A bun can also be a savory bread roll similar to a bap or barmcake....
increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration - Base deficit (negative base excessBase excessIn human physiology, base excess and base deficit refer to an excess or deficit, respectively, in the amount of base present in the blood. The value is usually reported as a concentration in units of mEq/L, with positive numbers indicating an excess of base and negative a deficit...
) > 5 mEq/L - Sequestration of fluids > 4 L
Alternatively, pancreatitis severity can be assessed by any of the following:
- APACHE IIAPACHE IIAPACHE II is a severity-of-disease classification system , one of several ICU scoring systems...
score ≥ 8 - Organ failure
- Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CTComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
)
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