Ranson-Kriterien-Rechner

What Are Ranson Criteria?

Ranson Criteria, published by Dr. John Ranson in 1974, represent one of the earliest and most widely recognized scoring systems for predicting the severity of acute pancreatitis. The system uses 11 clinical and laboratory criteria — 5 assessed at admission and 6 at 48 hours — to stratify patients into mild, moderate, severe, and critical categories based on predicted mortality. Separate criteria exist for gallstone pancreatitis (with slightly different thresholds) and non-gallstone pancreatitis.

Admission vs. 48-Hour Criteria

The five admission criteria assess the initial inflammatory burden: age, WBC count, blood glucose, serum LDH, and AST. The six 48-hour criteria reflect ongoing physiologic derangement and third-spacing: hematocrit decrease, BUN rise, serum calcium level, PaO₂, base deficit, and estimated fluid sequestration. This two-stage assessment captures both the initial severity and the trajectory of disease, which is critical because many patients with initially mild presentations progress to severe pancreatitis within the first 48–72 hours.

Limitations and Alternatives

The primary limitation of Ranson Criteria is the 48-hour delay required for full scoring, which can postpone clinical decision-making. Additionally, the criteria have moderate sensitivity and specificity and were derived from relatively small cohorts. Modern alternatives include the BISAP score (which can be calculated at admission), APACHE II (continuous ICU scoring), and the Revised Atlanta Classification (which defines severity based on organ failure and local complications). CT severity index (Balthazar score) adds imaging-based prognostic information. Despite these limitations, Ranson Criteria remain widely taught and used as a benchmark in pancreatitis severity assessment.

Key References

• Ranson JH, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.
• Banks PA, et al. Classification of acute pancreatitis — 2012: revision of the Atlanta classification. Gut. 2013;62(1):102-111.
• Papachristou GI, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure. Am J Gastroenterol. 2010;105(2):435-441.