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Ranson’s criteria

What is it, Uses, and More

Author: Anna Hernández, MD

Editors: Alyssa Haag, Józia McGowan, DO

Illustrator: Jillian Dunbar

Copyeditor: David G. Walker


What is Ranson’s criteria?

Ranson's criteria is a scoring system that helps healthcare professionals predict the severity and mortality of acute pancreatitis, an inflammatory condition of the pancreas that occurs primarily as a result of alcohol or gallstones

Most of the time, acute pancreatitis is relatively mild, with the inflammation resolving in the first few days after appropriate treatment. However, in around 20% of cases, it can become more severe and cause necrosis (i.e., tissue death) of the pancreas and surrounding fatty tissue. If the disease progresses, there may be a phase of generalized inflammation, also known as a systemic inflammatory response (SIRS), triggered by the release of various inflammatory molecules and pancreatic enzymes into the blood. If left untreated, SIRS can result in significant fluid sequestration, or shifting of fluid from blood vessels into the surrounding tissues, ultimately leading to organ failure. 

Besides Ranson's criteria, there are several other scoring systems that can be used to predict the severity of acute pancreatitis. These include the Revised Atlanta criteria, BISAP score, APACHE II classification, and Balthazar computed tomography (CT) severity index. 

How do you use Ranson’s criteria?

The Ranson’s criteria has a total of 11 prognostic signs that reflect on the severity of acute pancreatitis. Five of these parameters are assessed upon hospital admission, whereas the rest are assessed at 48 hours into admission. At admission, the measured parameters include age over 55 years, elevated white blood cell count (WBC), hyperglycemia (i.e., elevated blood glucose), elevated lactate dehydrogenase (LDH), and elevated serum aspartate transaminase (AST). At 48 hours, the criteria include low hematocrit, elevated blood urea nitrogen (BUN), low serum calcium, hypoxemia (i.e., low blood oxygen levels), markers of a low blood pH (i.e., metabolic acidosis), and fluid sequestration. 

This scoring system aims to predict the severity of acute pancreatitis by determining if there are any signs of dehydration (e.g., high BUN), inflammation (e.g., high WBC and LDH), or organ dysfunction (e.g., hypoxemia) as well as the ability of the pancreas to regulate glucose levels (e.g., presence of hyperglycemia). 

The presence of 1 to 3 of these aforementioned criteria indicates that severe pancreatitis is unlikely, while the presence of more than 3 criteria indicates an increased risk of severe pancreatitis and higher mortality.

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What are the most important facts to know about Ranson’s criteria?

The Ranson’s criteria is one of the many scoring systems that can be used to predict the severity and mortality of acute pancreatitis. It includes a total of 11 prognostic signs, five of which are assessed upon hospital admission and the other six after 48 hours. According to the criteria, a score of 3 or more represents an increased risk of developing severe pancreatitis and a higher mortality rate.

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Related links

Anatomy of the abdominal viscera: Pancreas and spleen
Pancreatic secretion
Pancreas histology
Acute pancreatitis
Pancreatitis: Clinical practice

Resources for research and reference

Conwell DL, Banks PA, Greenberger NJ. Acute Pancreatitis Pathogenesis and Diagnosis. In Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; Accessed July 11, 2021. 

Kuo, D. C., Rider, A. C., Estrada, P., Kim, D., & Pillow, M. T. (2015). Acute pancreatitis: What's the score?. The Journal of Emergency Medicine, 48(6), 762–770. DOI:10.1016/j.jemermed.2015.02.018

Waller, A., Long, B., Koyfman, A., & Gottlieb, M. (2018). Acute pancreatitis: Updates for emergency clinicians. The Journal of Emergency Medicine, 55(6), 769–779. DOI:10.1016/j.jemermed.2018.08.009