Use of Ranson score in acute pancreatitis

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Acute pancreatitis is a common gastrointestinal disease with many levels of severity, sometimes affecting life. Developed and developed in 1974, the ranson scale was the first scoring system to predict acute pancreatitis. Understanding what the ranson scale is and how to calculate the ranson scale will help timely intervention and treatment, improving acute pancreatitis for patients.

1. What is the ranson scale?

The ranson scale was originally a scoring system that used 11 parameters to assess the severity of acute pancreatitis, named after Dr. John Ranson, a surgeon and leading figure in the field. pancreas in the 20th century. Dr. Ranson introduced parameters in his 1974 paper on prognostic signs and the role of surgical management in acute pancreatitis. Accordingly, 11 objective parameters were identified as having significant prognostic value for predicting severe acute pancreatitis, including age, white blood cell count, blood glucose, serum aspartate transaminase (AST), lactate dehydrogenase serum (LDH), serum calcium, decreased hematocrit level, arterial oxygen (PaO2), blood urea nitrogen (BUN), base deficit, and blood sequestration. However, a ranson scale with 11 parameters was used to score cases of acute alcoholic pancreatitis, while a modified ranson scale with 10 parameters was used to score gallbladder pancreatitis. .
To date, the ranson scale remains one of the earliest scoring systems for assessing the severity of acute pancreatitis and continues to be widely used. Since its inception, following the ranson scale, at least 17 other scoring systems have been validated. In fact, the most widely used clinical prognostic scales for hospitalized patients with acute pancreatitis include the ranson score, the Glasgow prognostic criteria, the APACHE II classification system, and the enhanced Balthazar CT score system. High.

2. How is the ranson scale calculated?

The ranson scale is used to predict the severity and mortality of acute pancreatitis. Five parameters were evaluated immediately upon admission and the remaining six parameters were evaluated 48 hours after admission. One score was given for each positive parameter with a maximum score of 11 and a modified ranson scale with a maximum score of 10 with five parameters assessed on admission, the remaining five considered at 48 hour.
How to calculate the ranson scale based on 11 parameters used to assess the severity of alcoholic pancreatitis. Accordingly, 5 parameters on admission were age over 55, white blood cell count greater than 16,000 cells/cmm, blood glucose greater than 200 mg/dL (11 mmol/L), serum AST greater than 250 IU/L and serum LDH greater than 350 IU/L. At 48 hours, the remaining 6 parameters in the ranson scale were: serum calcium less than 8.0 mg/dL (less than 2.0 mmol/L), hematocrit greater than 10% decrease, PaO2 less than 60 mmHg, BUN increased by 5 mg/dL or more (1.8 mmol/L or more) despite intravenous fluids, base deficit greater than 4 mEq/L, and blood isolation greater than 6 L.
The modified ranson scale used to evaluate acute gallstone pancreatitis has five parameters on admission namely age over 70 years, white blood cell count greater than 18,000 cells/cmm, glucose blood pressure greater than 220 mg/dL (greater than 12.2 mmol/L), serum AST greater than 250 IU/L and serum LDH greater than 400 IU/L. After 48 hours, the remaining 5 parameters are calcium serum less than 8.0 mg/dL (less than 2.0 mmol/L), hematocrit decreased by more than 10%, BUN increased by 2 mg/dL or more (0.7 mmol/L or more) despite intravenous fluid rehydration, base deficit greater than 5 mEq/L and blood isolation greater than 4 L.
Ranson scale results will be interpreted Scored as follows:
0 to 2 points: 0% to 3% mortality 3 to 4 points: 15% mortality 5 to 6 points: 40% mortality 7 to 11: close 100% mortality

3. Clinical significance of ranson scale calculation

Ranson scoring is mainly used in an inpatient setting. Basically, the ranson score is used to determine the role of surgical treatment in cases of acute pancreatitis, because of the important parameters for multi-organ failure, response syndrome systemic inflammation (SIRS) and endovascular dysfunction.
Specifically, if the ranson scale gives a result of 0 or 1, it is predicted that complications will not develop and mortality will be negligible. Conversely, a score of 3 or higher predicts severe acute pancreatitis and the patient may face death. In these cases, severe acute pancreatitis is defined by the presence of any organ or local complications of the pancreas such as pseudocyst, abscess, or necrosis.

4. Concerns about the ranson scale

One limitation of the ranson scale is that later scoring systems have shown superiority in sensitivity or specificity. Indeed, in a 2016 meta-analysis, a ranson score greater than 2 points had an average sensitivity and specificity of 90% and 67.4%, respectively. In this same meta-analysis, other scoring systems with better sensitivity or specificity, for example, an APACHE-II score greater than 7 has an average sensitivity of 100%.
The second limitation in the calculation of the ranson scale is that the score and severity of acute pancreatitis cannot be determined until 48 hours have passed since admission. This limits the applicability of the ranson scale in time-sensitive situations such as the emergency department. In addition, because there are 11 parameters to collect, the calculation of the ranson scale will make it difficult to use it conveniently and quickly. Meanwhile, other scoring systems such as APACHE-II can be applied at any time and are the scoring systems used in the critical care department. Likewise, the Bed Severity Index for Acute Pancreatitis (BISAP) is another scoring system that can also be used at any time and is universally used by emergency medical practitioners. more variable than the calculation of the ranson scale.
The third limitation of the ranson scale is that the Ranson team initially only included patients between the ages of 30 and 75. Therefore, the ranson scale would not be able to be used for child or adolescent populations. This has been demonstrated in studies showing that the ranson scale has only a sensitivity of 51.8% and a negative predictive value of 83.2%.

5. Suggestions for improving the calculation of the ranson scale

Because of the limitations of the ranson scale above, other factors are also used to aid in the assessment of the severity of acute pancreatitis. Elevated BUN on admission was found to be associated with increased severity of acute pancreatitis and/or risk of death. Elevated BUN values ​​are thought to be a reflection of intravascular volume depletion, which is driven by inflammatory mediators in response to acute inflammation. The APACHE score has a major advantage over the Ranson criteria in that it can be used to evaluate patients at any point of admission. However, a major drawback of the APACHE score is that it is labor intensive to evaluate.
A commonly used test parameter for staging acute pancreatitis is the hematocrit . Hematocrit greater than 47% on admission has been shown to be a good prognostic factor for pancreatic necrosis. Other markers also used to stage acute pancreatitis include CRP and interleukin-6 levels. Many other biomarkers have shown promise in predicting the severity of acute pancreatitis (eg, trypsinogen-activating peptide, phospholipase A2, and polymorphonuclear elastase), but not all are better. compared to using CRP.
It is important to understand that imaging is not indicated to evaluate a patient with mild acute pancreatitis unless the patient is suspected of having a malignancy. However, abdominal computed tomography is always indicated in patients with severe acute pancreatitis and is the imaging modality of choice in patients with complications. CT scans are rarely needed within the first three days of admission unless the diagnosis is in doubt because most inflammatory changes are not usually seen on radiographs at this time.
Finally, in some cases of severe acute pancreatitis, patients may need imaging-guided aspiration aspiration to distinguish aseptic necrosis from purulent infection.
In summary, the ranson scale has been used to assess the severity of acute pancreatitis over the past few decades. Over time, more and more tools have been proposed to improve the sensitivity and specificity of ranson scoring. However, it is important that patients with acute pancreatitis be evaluated by a professional team that includes a gastroenterologist, surgeon, endocrinologist, and radiologist; Patients with moderate to severe acute pancreatitis are best followed by critical care medical personnel. At the same time, the entire assurance team can understand what the value of each parameter in the ranson scale is, select other appropriate scoring criteria to assess the severity of the condition, and apply it appropriately. sensitive in each clinical setting.

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