Ranson Criteria Calculator
Predict severity and mortality in acute pancreatitis using Ranson's criteria. Evaluates 5 parameters at admission and 6 parameters at 48 hours.
At Admission (Within 48 Hours)
Positive if > 55 years
Positive if > 16,000/μL
Positive if > 200 mg/dL
Positive if > 350 U/L
Positive if > 250 U/L
At 48 Hours
Positive if > 10% decrease
Positive if > 5 mg/dL increase
Positive if < 8 mg/dL
Positive if < 60 mmHg
Positive if > 4 mEq/L
Positive if > 6 liters
Scoring Interpretation
| Score | Severity | Mortality Rate | Management |
|---|---|---|---|
| 0-2 | Mild | < 1-2% | General ward care, supportive treatment |
| 3-4 | Moderate | ~15% | Close monitoring, consider ICU |
| 5-6 | Severe | ~40% | ICU admission strongly recommended |
| ≥7 | Very Severe | Nearly 100% | Immediate ICU, aggressive intervention |
Note: Ranson's criteria cannot be fully calculated until 48 hours after admission. For earlier assessment, consider using BISAP or APACHE-II scores.
About Ranson's Criteria
Ranson's criteria is a clinical prediction rule for assessing the severity and prognosis of acute pancreatitis. Developed by Dr. John Ranson in 1974, it remains one of the most widely used scoring systems for pancreatitis despite requiring 48 hours to complete.
Clinical Significance
- Predicts mortality risk with good accuracy when fully calculated
- Guides decisions on ICU admission and level of care
- Helps identify patients at high risk of complications
- Useful for prognostication and family counseling
- Validated extensively in multiple populations
Limitations
- Requires 48 hours to calculate all parameters
- Cannot provide early risk stratification
- Less accurate in non-gallstone, non-alcoholic pancreatitis
- Some parameters (fluid sequestration) can be difficult to measure accurately
- Not applicable to chronic pancreatitis
Alternative Scoring Systems
BISAP score can be calculated within 24 hours and provides earlier risk stratification. APACHE-II can be calculated at any time but is more complex. The Atlanta classification also incorporates imaging findings for comprehensive assessment.
Frequently Asked Questions
Why does Ranson's criteria take 48 hours to complete?
Six of the eleven criteria require laboratory values obtained at 48 hours after admission to assess the dynamic changes in the patient's condition. These changes (like hematocrit drop and BUN increase) reflect disease progression and severity.
What is fluid sequestration and how is it measured?
Fluid sequestration refers to the amount of IV fluid administered minus urine output over the first 48 hours. It reflects third-spacing of fluids into the retroperitoneum and bowel. Greater than 6 liters indicates severe inflammation and poor prognosis.
Is Ranson's criteria different for gallstone vs. alcoholic pancreatitis?
Yes, there is a modified version for gallstone pancreatitis with slightly different cutoffs. The original criteria were developed primarily for alcoholic pancreatitis but have been adapted for other etiologies.
Can Ranson's criteria predict specific complications?
While primarily designed to predict mortality, higher Ranson scores correlate with increased risk of specific complications including pancreatic necrosis, pseudocyst formation, respiratory failure, and renal failure.
Should I wait 48 hours before making treatment decisions?
No. Treatment should be initiated immediately based on clinical presentation. The admission criteria can provide early risk assessment, and other scores like BISAP can be used for earlier stratification. Ranson's is used for prognosis and long-term planning.
What happens if I have partial criteria at admission?
You can calculate the admission score (0-5) initially for preliminary assessment. The full predictive power requires all 11 criteria at 48 hours. Even a high admission score warrants close monitoring and aggressive early treatment.
How accurate is Ranson's criteria?
Ranson's criteria has good predictive accuracy with an AUC of approximately 0.75-0.85 for mortality prediction. Scores of 0-2 have excellent negative predictive value (low mortality risk), while scores ≥6 strongly predict severe disease.
Can Ranson's criteria be used in children?
Ranson's criteria were developed and validated in adult populations. Pediatric pancreatitis requires different assessment tools as the etiology, course, and prognosis differ significantly from adults.
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