How many points indicate severe acute pancreatitis by Ranson's criteria?

A Ranson score of 3 or more points is generally associated with severe acute pancreatitis and a higher risk of complications and mortality. Scores of 0–2 usually indicate mild disease, 3–4 moderate, and 5 or more severe disease with high mortality risk.

What is the mortality risk by Ranson score?

Classic estimates for non-gallstone pancreatitis are: 0–2 points: <5% mortality; 3–4 points: about 15–20%; 5–6 points: about 40%; 7–11 points: nearly 100%. Modern cohorts may have lower mortality due to improved care, so these numbers should be interpreted cautiously.

What is the difference between gallstone and non-gallstone Ranson's criteria?

The Ranson score uses slightly different thresholds for gallstone versus non-gallstone pancreatitis. For gallstone pancreatitis, age ≥70 years and AST >250 IU/L are used, while for non-gallstone pancreatitis, age >55 years and LDH >350 IU/L plus AST >250 IU/L are used. The remaining criteria are the same.

Ranson's Criteria Calculator for Acute Pancreatitis

Q: What is Ranson's criteria used for?

Ranson's criteria is a clinical scoring system used to estimate the severity and mortality risk of acute pancreatitis. It uses 11 clinical and laboratory variables measured at admission and within the first 48 hours to stratify patients into low-, moderate-, and high-risk groups.

Q: What is the difference between gallstone and non-gallstone Ranson's criteria?

The Ranson score uses slightly different thresholds for gallstone versus non-gallstone pancreatitis. For gallstone pancreatitis, age ≥70 years and AST >250 IU/L are used, while for non-gallstone pancreatitis, age >55 years and LDH >350 IU/L plus AST >250 IU/L are used. The remaining criteria are the same.

Q: Can I use Ranson's criteria at admission only?

Ranson's criteria was designed to be applied at admission and again at 48 hours. Admission criteria alone provide an early estimate of severity, but the full prognostic value comes from including the 48-hour criteria. If 48-hour data are not yet available, you can still interpret the admission score as a preliminary risk estimate.

Estimate severity and in-hospital mortality risk in acute pancreatitis using classic Ranson's criteria at admission and 48 hours.

Educational tool only. Not for self-diagnosis or treatment. Always use clinical judgment and local guidelines.

Choose pancreatitis etiology

Ranson's criteria use slightly different thresholds for gallstone vs non-gallstone pancreatitis.

Non-gallstone (e.g., alcoholic, idiopathic) Gallstone pancreatitis

Admission criteria (within first 24 hours)

0 / 5 met

Age (years)

Non-gallstone: > 55 years

WBC (×10⁹/L)

Criterion: WBC > 16 ×10⁹/L

Blood glucose (mg/dL)

Non-gallstone: > 200 mg/dL | Gallstone: > 250 mg/dL

LDH (IU/L)

Non-gallstone: LDH > 350 IU/L (used if non-gallstone)

AST (IU/L)

Criterion: AST > 250 IU/L (used in both variants)

Note: For non-gallstone pancreatitis, both LDH and AST criteria can contribute points. For gallstone pancreatitis, only AST is used.

48-hour criteria

0 / 6 met

If 48‑hour data are not yet available, you can leave these blank. The calculator will still compute the admission score.

Hematocrit fall (%)

Criterion: Hct fall > 10 percentage points

BUN rise (mg/dL)

Criterion: BUN increase > 5 mg/dL

Serum calcium (mg/dL)

Criterion: Calcium < 8.0 mg/dL

Arterial PO₂ (mmHg)

Criterion: PO₂ < 60 mmHg

Base deficit (mEq/L)

Criterion: Base deficit > 4 mEq/L

Estimated fluid sequestration (L)

Criterion: Fluid sequestration > 6 L

What is Ranson's criteria?

Ranson's criteria is one of the earliest and best-known scoring systems for predicting severity and mortality in acute pancreatitis. It uses 11 clinical and laboratory variables measured at admission and within the first 48 hours to stratify patients into risk categories.

The score was originally derived separately for non-gallstone (often alcoholic) pancreatitis and for gallstone pancreatitis, with slightly different thresholds for age and enzymes.

Ranson's criteria for non-gallstone pancreatitis

At admission (5 criteria):

Age > 55 years
WBC > 16 ×10⁹/L
Blood glucose > 200 mg/dL (11.1 mmol/L)
LDH > 350 IU/L
AST > 250 IU/L

Within 48 hours (6 criteria):

Hematocrit fall > 10 percentage points
BUN increase > 5 mg/dL despite fluids
Serum calcium < 8.0 mg/dL (2.0 mmol/L)
Arterial PO₂ < 60 mmHg
Base deficit > 4 mEq/L
Estimated fluid sequestration > 6 L

Ranson's criteria for gallstone pancreatitis

At admission (5 criteria):

Age ≥ 70 years
WBC > 18 ×10⁹/L
Blood glucose > 250 mg/dL (13.9 mmol/L)
AST > 250 IU/L
LDH is not part of the original gallstone set (our calculator still displays LDH but does not count it for gallstone etiology).

Within 48 hours (same 6 criteria as above):

Hematocrit fall > 10 percentage points
BUN increase > 5 mg/dL
Serum calcium < 8.0 mg/dL
Arterial PO₂ < 60 mmHg
Base deficit > 4 mEq/L
Fluid sequestration > 6 L

How the Ranson score is interpreted

Classic mortality estimates (non-gallstone cohorts):

0–2 points: < 5% mortality
3–4 points: ≈ 15–20% mortality
5–6 points: ≈ 40% mortality
7–11 points: ≈ 100% mortality

Modern ICU care has improved outcomes, so actual mortality may be lower than these historic figures. However, higher scores still correlate with more severe disease and higher risk of complications.

Strengths and limitations

Strengths: Well-validated historically, uses widely available labs, separates admission and 48‑hour risk.
Limitations: Requires 48 hours for full score, may overestimate mortality in current practice, less practical in the ED compared with newer scores (e.g., BISAP, APACHE II).

Clinical pearls

A high admission score (≥3) should prompt early aggressive resuscitation, close monitoring, and consideration of ICU-level care.
Rising BUN and large fluid sequestration at 48 hours are particularly concerning for poor outcomes.
Always interpret Ranson's criteria alongside other severity scores, imaging, organ failure, and local guidelines.

Disclaimer

This calculator is provided for educational purposes to support, not replace, clinical decision-making. It does not provide medical advice, diagnosis, or treatment. Always consult appropriate clinical resources and use your professional judgment.

Frequently Asked Questions

Is Ranson's criteria still used in practice?

Yes, Ranson's criteria is still referenced, especially in textbooks and exams, but many centers now favor simpler or more dynamic scores such as BISAP, APACHE II, or the Marshall score. Ranson's criteria remains useful for understanding risk stratification and for research comparisons.

Can I calculate a Ranson score without 48-hour labs?

You can calculate an admission Ranson score using the first 5 criteria. This provides an early estimate of severity, but the full prognostic value comes from including the 48‑hour criteria. Our calculator reports both admission and 48‑hour components separately.

Does this calculator support SI units?

The original Ranson thresholds are defined in conventional units (mg/dL, IU/L, mmHg). If your lab reports in SI units (e.g., mmol/L), convert to the corresponding conventional units before entering values. A future update may add automatic unit conversion.

How does this differ from APACHE II or BISAP?

Ranson's criteria is specific to acute pancreatitis and uses 11 variables over 48 hours. APACHE II is a general ICU severity score using many more variables, while BISAP is a simpler 5‑point score that can be calculated within 24 hours. Each has different strengths; no single score should be used in isolation.