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Severity Criteria for Acute Pancreatitis

 

Ranson Criteria to Predict Severity of Acute Pancreatitis

 

1. When three or more of the following are present on admission, a severe course complicated by pancreatic necrosis can be predicted with a sensitivity of 60-80%:

  • Age over 55 years.

  • White blood cell count over 16,000/uL.

  • Blood glucose over 200 mg/dL.

  • Serum lactate dehydrogenase (LDH) over 350 units/L.

  • Aspartate aminotransferase (AST, SGOT) over 250 units/L.

2. Development of the following in the first 48 hours indicates a worsening prognosis:

  • Hematocrit drop of more than ten percentage points.

  • Blood urea nitrogen (BUN) rise greater than 5 mg/dL.

  • Arterial PO2 of less than 60 mm Hg.

  • Serum calcium of less than 8 mg/dL.

  • Base deficit over 4 meq/L.

  • Estimated fluid sequestration of more than 6 L.

3. Mortality rates correlate with the number of criteria present:

 

Number of criteria    

Mortality rate

0-2

1%

3-4

16%

5-6

40%

7-8

100%

  

 

Balthazar CT severity index for acute pancreatitis.

 

CT Grade

Points

Necrosis

(%)

Additional

Points

Severity

Index

Mortality

Rate (%)

A Normal pancreas

0

0

0

0

0

B Pancreatic enlargement

1

0

0

1

0

C Pancreatic inflammation and/or peripancreatic fat

2

< 30

2

4

0

D Single peripancreatic fluid collection

3

30-50

4

7

> 17

E Two or more fluid collections or retroperitoneal air

4

> 50

6

10

 

 

References:

  1. Ranson JH. Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol. 1984 Sep;13(3):843-63. [Medline]

  2. Balthazar EJ: Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002;223:603. [Medline]

Created: January 07, 2006
Last Modified: 03/06/2006