Ranson′s criteria for acute pancreatitis in high altitude: Do they need to be modified?

• Main Authors: Abu-Eshy Saeed, Abolfotouh Mostafa, Nawar Eldawi, Abu Sabib Abdul-Rahman
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2008-01-01
• Series: The Saudi Journal of Gastroenterology
• Subjects: Acute; high altitude; pancreatitis; Ranson′s criteria; Saudi Arabia; severity prediction
• Online Access: http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2008;volume=14;issue=1;spage=20;epage=23;aulast=Abu-Eshy

<b>Background/Aim:</b> To examine the validity of Ranson&#x2032;s criteria in the prediction of the severity of acute pancreatitis (as judged by the occurrence of complications) in a high-altitude area of Saudi Arabia with a predominant biliary pancreatitis. <b> Materials and Methods:</b> All consecutive cases of acute pancreatitis (AP) admitted to a tertiary care hospital over a two-and-half-year period were included in this prospective study. Ranson&#x2032;s criteria (RC) were used to determine the severity of the attack of AP, which was then correlated with the occurrence of complications. The validity of Ranson&#x2032;s score and that of each of its individual components was estimated. Using receiver operating characteristic (ROC) curve, new optimum values for these components were calculated and a new modified score was constructed. <b> Results:</b> Seventy-three attacks of AP in 69 patients formed the material of this study. Ranson&#x2032;s prediction criteria classified 43.8&#x0025; of the attacks as "severe", but only 22&#x0025; of those attacks were associated with complications. Calcium level (&#60; 8 mg/dl) was the only criterion that was significantly associated with complications (Kappa = 0.32, <i> p</i>0 = 0.02). Using ROC curve to determine the optimum cut-off levels for prediction identified only four criteria, which were significantly associated with complications as compared with the original Ranson&#x2032;s cut-off levels. Those were: a serum glucose value of &#8805;160 mg/dl (<i> P</i> &lt; 0.05), blood urea nitrogen rise of &#8805;35 mg/dl (<i> P</i> &lt; 0.02) and an arterial Po₂ value of &#8804;55 mm Hg (<i> P</i> &lt; 0.01), in addition to calcium value of &#60; 8 mg/dl (<i> P</i> = 0.02) as originally set by Ranson. A new scoring system, ranging from 0 to 4, based on these cut-off levels, together with a calcium level of &#60; 8 mg/dl, could correctly classify the severity of AP. A total score of two or more points predicted a severe attack with a sensitivity of 88&#x0025;, a specificity of 82&#x0025; and a Kappa coefficient of 0.47 (<i> P</i> &lt; 0.001). <b> Conclusion:</b> This study showed that Ranson&#x2032;s criteria may need to be modified in high altitude with a predominant biliary pancreatitis in order to accurately predict the severity of AP.