Gastroenterology
Ranson Criteria (admission)
Early severity markers in acute pancreatitis.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Ranson criteria are a classic prognostic system for acute pancreatitis, of which five are assessed on admission and the remainder at 48 hours. This calculator covers the five admission (non-gallstone) criteria: age over 55, white cell count above 16 ×10⁹/L, glucose above 11.1 mmol/L, AST above 250 U/L and LDH above 350 U/L. Each present criterion scores one point. They were derived to identify, early, those patients at higher risk of a severe course.
Interpreting the result
Within the admission criteria, a higher count signals greater predicted severity, with 0–2 representing lower and 3–5 higher predicted severity. The full Ranson score (admission plus 48-hour criteria) correlates with mortality, which rises substantially as the total number of positive criteria increases. The admission criteria alone give an early flag but are incomplete, so re-assessment at 48 hours is essential. As always, the score supports rather than replaces clinical judgement.
Worked example
A 58-year-old admitted with acute pancreatitis has age over 55 (1), white cell count 18 ×10⁹/L (1) and glucose 12 mmol/L (1), giving 3 of the 5 admission criteria. This flags higher early predicted severity and prompts close monitoring with formal re-scoring at 48 hours.
Critical actions
These are the admission (non-gallstone) criteria only. The full Ranson score requires re-assessment at 48 hours.
Pearls / pitfalls
- These are the admission (non-gallstone) criteria only — the complete score requires the additional criteria measured at 48 hours.
- The system was derived mainly in alcohol-related disease, and a separate set of cut-offs exists for gallstone pancreatitis.
- Its main limitation is that the full score cannot be completed until 48 hours, delaying definitive risk stratification.
- A low admission count does not exclude later severe disease; serial clinical review remains essential.
Evidence & validation
Described by Ranson and colleagues in 1974 in patients largely with alcohol-related pancreatitis; it is widely recognised historically, though its need for 48-hour data and modest performance mean many units now favour scores such as Glasgow-Imrie or APACHE alongside CRP.
Frequently asked questions
How many Ranson criteria are assessed on admission?
Five criteria are assessed on admission: age over 55, white cell count above 16 ×10⁹/L, glucose above 11.1 mmol/L, AST above 250 U/L and LDH above 350 U/L. The remaining criteria are measured at 48 hours.
Why can't the full score be calculated at presentation?
Several Ranson criteria — such as the fall in haematocrit, rise in urea, calcium, base deficit and fluid needs — are defined over the first 48 hours, so the complete score is only available after that point.
Is there a different version for gallstone pancreatitis?
Yes. Ranson described separate cut-offs for gallstone (biliary) pancreatitis, which differ slightly from the original alcohol-related criteria, so the correct set should be used for the suspected aetiology.
How does the Ranson score relate to mortality?
Mortality rises markedly as the total number of positive criteria increases, with very high counts associated with a poor prognosis. The admission criteria alone give only an early, partial estimate.
Is Ranson still used today?
It is still widely taught and recognised, but many units prefer alternatives such as Glasgow-Imrie, APACHE II and CRP because Ranson requires 48-hour data and has only modest predictive accuracy.
References
- Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69–81.
- Working Party of the British Society of Gastroenterology. UK guidelines for the management of acute pancreatitis. Gut. 2005.
About the creator
Ranson JH et al.
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