Ranson criteria (acute pancreatitis)
Severity of non-gallstone acute pancreatitis at admission and 48 h
Sources last checked: 2026-10-13
Ranson criteria (acute pancreatitis)
Severity of non-gallstone acute pancreatitis at admission and 48 h
Mortality about 1 % in Ranson's series.
These are the 1974 criteria for non-gallstone (mainly alcoholic) pancreatitis; gallstone pancreatitis has a separate set with higher thresholds. The full score is only available at 48 h, and severity today is defined by persistent organ failure (revised Atlanta).
Interpretation
| 0–2 — mild course likely | Mortality about 1 % in Ranson's series. |
|---|---|
| 3–4 — severe pancreatitis predicted | Mortality about 15 % in Ranson's series. |
| 5–6 | Mortality about 40 %. |
| ≥ 7 | Mortality approached 100 % in the original series. |
What is the Ranson criteria (acute pancreatitis)?
Ranson's criteria are 11 prognostic signs of acute pancreatitis — five at admission and six during the first 48 hours. Ranson and colleagues described them in 1974 in a New York series, mostly of alcohol-related pancreatitis. Three or more signs predict a severe course, and mortality rises steeply with the count.
When to use it
- Severity assessment of acute pancreatitis not caused by gallstones, completed at 48 h
- Teaching the pathophysiology of severe pancreatitis
- Research and audit where comparability with older series matters
When not to use it
- Gallstone pancreatitis — a modified set with different thresholds applies
- Early triage at presentation, when only five criteria are available
- Defining severity, which today follows the revised Atlanta classification (persistent organ failure)
How it is calculated
| Criterion | Points |
|---|---|
| Admission: age > 55 years | +1 |
| Admission: WBC > 16 × 10⁹/L (> 16 000/mm³) | +1 |
| Admission: glucose > 200 mg/dL (> 11.1 mmol/L) | +1 |
| Admission: LDH > 350 IU/L | +1 |
| Admission: AST > 250 IU/L | +1 |
| 48 h: haematocrit fall > 10 percentage points | +1 |
| 48 h: BUN rise > 5 mg/dL (urea rise > 1.8 mmol/L) | +1 |
| 48 h: calcium < 8 mg/dL (< 2.0 mmol/L) | +1 |
| 48 h: PaO₂ < 60 mmHg (< 8 kPa) | +1 |
| 48 h: base deficit > 4 mmol/L | +1 |
| 48 h: estimated fluid sequestration > 6 L | +1 |
Clinical pearls and limitations
- These are the 1974 criteria for non-gallstone (mainly alcoholic) pancreatitis; gallstone pancreatitis has a separate set with higher thresholds. The full score is only available at 48 h, and severity today is defined by persistent organ failure (revised Atlanta).
- The 48-hour items are changes from admission (haematocrit fall, BUN rise) — record admission values.
- Fluid sequestration is estimated as fluid given minus fluid lost; it depends on how aggressively fluids were given.
- IAP/APA guidance prefers persistent SIRS for early risk stratification; Ranson is mostly of historical and comparative value.
- Calcium here is total serum calcium; correct for albumin with caution.
Frequently asked questions
What are Ranson's criteria at admission?
Age > 55, WBC > 16 000/mm³, glucose > 200 mg/dL (11.1 mmol/L), LDH > 350 IU/L and AST > 250 IU/L.
What Ranson score means severe pancreatitis?
Three or more signs predict severe pancreatitis.
Why does Ranson differ for gallstone pancreatitis?
Ranson published a modified set in 1982 with higher thresholds (e.g. age > 70, WBC > 18 000) because biliary pancreatitis behaved differently.
Evidence and guidelines
- Primary source: Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139(1):69-81 (PMID 4834279). Thresholds as tabulated in open-access reviews (e.g. PMC9227091, PMC8684888).
- Ranson JH. Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 1982;77(9):633-638 (modified criteria for gallstone pancreatitis).
- Working Group IAP/APA. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13(4 Suppl 2):e1-15 — prefers persistent SIRS over multi-factor scores for early stratification.
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