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Ranson criteria

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Ranson criteria
Purposeassess mortality risk of acute pancreatitis

TheRanson criteriaform aclinical prediction rulefor predicting the prognosis and mortality risk ofacute pancreatitis.They were introduced in 1974 by theEnglish-Americanpancreaticexpert andsurgeonDr. John Ranson (1938–1995).[1]

Usage

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A score of 3 or more indicates severe acute pancreatitis. This can causeorgan failure,necrosis,infected necrosis,pseudocyst,andabscess.If diagnosed with severe acute pancreatitis, people will need to be admitted to ahigh-dependency unitorintensive care unit.

Acute pancreatitis not secondary to gallstones

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At admission:

  1. Blood glucose> 11.11 mmol/L (> 200 mg/dL)
  2. Age > 55 years
  3. SerumLDH> 350 IU/L
  4. SerumAST> 250 IU/L
  5. WBCcount > 16000 cells/mm3

Within 48 hours:

  1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
  2. Hematocritdecreased by > 10%
  3. Oxygen (hypoxemiawith PaO2< 60 mmHg)
  4. BUNincreased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
  5. Base deficit (negativebase excess) > 4 mEq/L
  6. Sequestration of fluids > 6 L

Acute pancreatitis secondary to gallstones

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At admission:

  1. Glucose > 220 mg/dl
  2. Age > 70 years
  3. LDH > 400 IU/L
  4. AST > 250 IU/ 100 ml
  5. WBC count > 18000 cells/mm3

Within 48 hours:

  1. Serum calcium < 8 mg/dL
  2. Hematocrit decreased by > 10%
  3. Base deficit > 4 mEq/L
  4. BUN increased by > 2 mg/dL
  5. Sequestered fluid > 6L

Alternatives

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Alternatively, pancreatitis severity can be assessed by any of the following:[2]

  • APACHE IIscore ≥ 8
  • Balthazar computed tomography severity index (CTSI)
  • BISAP score
  • Organ failure
  • Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhancedCT)
  • Modified Glasgow Criteria

Interpretation

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  • 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

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  1. ^Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC (1974). "Prognostic signs and the role of operative management in acute pancreatitis".Surgery, Gynecology & Obstetrics.139(1): 69–81.PMID4834279.
  2. ^Baron, Todd H.; Desiree E. Morgan (1999-05-06)."Acute Necrotizing Pancreatitis".N Engl J Med.340(18): 1412–1417.doi:10.1056/NEJM199905063401807.PMID10228193.Retrieved2009-02-08.