The major determinants of outcome are the extent of pancreatic necrosis and subsequent release of toxic substances, the presence of extrapancreatic necrosis, and secondary bacterial contamination of these devitalized areas. With advances in care, most patients survive the multiple and remote organ failures that characterize the early stage of the attack. Pancreatic infection is now the leading cause of death.

Patients with many signs of severity may have an uncomplicated course, and some with few signs may progress to necrosis, infection, and multiple organ failure. Nevertheless, these multiple prognostic criteria allow identification of most patients with severe episodes within a few hours of admission. Importantly, the timely value of each prognostic criterion relies on the successive phases of acute pancreatitis: inflammation, necrosis, and bacterial contamination. Early and sequential assessment of the severity of acute pancreatitis with complementary indicators adapted to each stage of the disease is a prerequisite to any improvement in therapy and survival. Whether early prediction of severity really influences treatment and outcome remains controversial.

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