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To the Editor: Using Ranson's criteria to forecast outcome in patients with pancreatitis would indicate that a 56-year-old individual with a glucose level of 201 mg/dL (11.2 mmol/L) and a white blood cell count of 16.1 x10³/µL has the same risk for adverse outcome as one who develops a PO₂of less than 60 mm Hg, has a decrease in hematocrit by 10%, and sequesters 6 L of abdominal fluid in 48 hours.¹ I would call into question the validity of a scoring system that equally weights these disparate factors.

An important article by Ranson and Pasternack² used versions of stepwise regression analysis to search for the criteria most predictive of acute pancreatitis. In this article, the 11 variables of Ranson were not equivalent in predictive value. Elevated lactate dehydrogenase and aspartate aminotransferase in the several tested models had the greatest prognostic capability.² I consider lactate dehydrogenase and . . . [Full Text of this Article]

Stephen Piwinski, MD, MOH
piwinski@uthscsa.edu
Department of Medicine
University of Texas Health Science Center
San Antonio

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