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 |
CT severity index equals unenhanced CT score plus necrosis score (based upon contrast enhanced CT) : maximum = 10, >/=6 = severe disease.
References:
Created: Jan 07, 2006
