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Ranson Criteria

Ranson Criteria: Gold standard for predicting severity and mortality in acute pancreatitis. Requires 48h longitudinal assessment.

On Admission

At 48 Hours

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Traditional severity stratification of patients with acute pancreatitis (AP)

To predict morbidity and mortality during the first 48 hours of admission

Historical gold-standard scoring historically used in surgical training and landmark trials

The 48-Hour Constraint

Ranson criteria require 48 hours for complete calculation. They cannot be used for "real-time" triage in the Emergency Department. For immediate triage, use BISAP or HAPS.

Section 2

Formula & Logic

At Admission (5 items)

Age > 55 years.

WBC > 16,000 /mm³.

Glucose > 200 mg/dL (11.1 mmol/L).

AST > 250 U/L.

LDH > 350 U/L.

At 48 Hours (6 items)

Haematocrit Fall > 10%.

BUN Rise > 5 mg/dL.

Calcium < 8 mg/dL.

PO2 < 60 mmHg.

Base Deficit > 4 mEq/L.

Fluid Sequestration > 6 L.

Mortality Prediction

0–2 Points	< 1% Mortality
3–4 Points	15% Mortality (Severe)
5–6 Points	40% Mortality
> 6 Points	> 70% Mortality

Section 3

Pearls/Pitfalls

Ranson vs. APACHE II

APACHE II can be calculated daily and has a higher predictive power for organ failure. However, Ranson remains popular due to its historical legacy and its focus on the "metabolic shift" (Calcium/Fluid/Hct) that occurs in the first 48 hours of necrotizing pancreatitis.

The 6L Fluid Rule

Sequestration of > 6 liters of fluid over 48 hours is a devastating marker of massive systemic capillary leak. These patients require aggressive hemodynamic monitoring (central lines / ICU) to prevent circulatory collapse.

Clinical Pearls

For Gallstone Pancreatitis, the thresholds are slightly lower (e.g., Age > 70, Glucose > 220) but follow the same structure

Hypocalcaemia reflects "saponification" (calcium binding to fatty acids in pancreatic necrosis)

Base deficit and PO2 reflect the developing systemic multi-organ failure (MOF) spectrum

Section 4

Next Steps

Triage Recommendation

Score ≥ 3: "Severe Acute Pancreatitis." Admit to High-care or ICU; Early enteral nutrition; Aggressive hydration.

Score < 3: Ward care; optimize pain management.

Complementary Scoring

BISAP Score (Acute triage)

APACHE II Score

HAPS (Harmless Pancreatitis Score)

Section 5

Evidence Appraisal

The Foundational Paper

Prognostic signs and the role of operative management in acute pancreatitis.

Ranson JH et al. • Surgery, Gynecology & Obstetrics. 1974;139(1):69-81. The landmark study defining the 11 signs.

View Source

Section 6

Literature

John H.C. Ranson

Developed by Dr. John Ranson at New York University. At the time, surgeons struggled to identify which AP patients needed immediate surgery vs. expectant management. Ranson proved that "laboratory-based physiological stress" was the strongest predictor of outcome.

Last Comprehensive Review: 2026

Related Gastroenterology Tools

Glasgow-Blatchford Score

AIMS65 Score

Forrest Classification

Rockall Score

BISAP Score

Harvey-Bradshaw Index

Crohn's Disease Activity Index

Mayo Score

Truelove & Witts Criteria

Adenoma Detection Rate

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