Background. Severe acute pancreatitis (SAP) is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU). Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010. Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8)). The most common aetiologies were alcohol (40%) and gallstones (30%). On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI) was 4. Forty patients (80%) tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, ). ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy. Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity. 1. Introduction Acute pancreatitis affects 22.4 people per 100？000 of the general UK population per annum [1]. The incidence has risen by 46% over the last three decades with an epidemiological trend towards younger, female patients and alcohol as the main aetiology. Approximately 25% of patients with acute pancreatitis develop severe disease with associated organ dysfunction and require admission to the Intensive Care Unit (ICU) [2]. Although the mortality rate for the mild form of the disease is as low as 1%, severe acute pancreatitis (SAP) is still associated with high mortality and a prolonged stay in the ICU [3]. According to the Intensive Care National Audit & Research Centre (ICNARC), between 1995 and 2003 in the UK, 2677 patients with SAP were admitted to an ICU, and ICU mortality and hospital mortality were 31% and 42%, respectively [4]. There are several different scoring systems aimed at identifying patients with a high risk of a more complicated course. The Ranson and Glasgow (Imrie) criteria are the most commonly used [5, 6]. The Computed Tomography Severity Index (CTSI) is another score that has been shown to have good predictive
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