Clinical Scoring Systems

In-Shorts

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Ranson criteria

Acute pancreatitis not secondary to gallstones
At admission:

1. Blood glucose > 11.11 mmol/L (> 200 mg/dL)
2. Age > 55 years
3. Serum LDH > 350 IU/L
4. Serum AST > 250 IU/L
5. WBC count > 16000 cells/mm3

Within 48 hours:

1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit decreased by > 10%
3. Oxygen (hypoxemia with PaO2 < 60 mmHg) BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
4. Base deficit (negative base excess) > 4 mEq/L
5. Sequestration of fluids > 6 L
6. Acute pancreatitis secondary to gallstones

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 Hematocrit decreased by > 10%
2. Base deficit > 4 mEq/L
3. BUN increased by > 2 mg/dL
4. Sequestered fluid > 6L

Interpretation

• 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

Pancreatitis severity can be assessed by any of the following:

1. Ranson criteria
2. APACHE II score ≥ 8
   
3. Balthazar computed tomography severity index (CTSI)
   
4. BISAP score
   
5. Organ failure
6. Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CT)

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