Severe pancreatitis is typically associated with (multi-) organ failure originating from local and systemic complications, and requires intensive, often specialised, interdisciplinary management including complex interventions. Severity originates from a “double hit” mechanism, involving an initial phase dominated by the systemic inflammatory response syndrome (SIRS); and, often after transient improvement, subsequent deterioration due to secondary septic complications driven by infected necrosis or pseudocysts. Hence, a prolonged course with consumption of considerable resources is common, and mortality is still substantial. As prevention or early and effective treatment of complications and organ failure count among the most important management aims, it is therefore pivotal to anticipate severe disease with reasonable accuracy. On the other hand, most patients with acute pancreatitis have a mild, uneventful and uncomplicated course, characterised by absence of organ failure or deaths; they can be treated on a peripheral ward and discharged home within a few days. In these patients, unnecessary (over-) treatment should be avoided in the interest of the patient and healthcare resources.

In consequence, intensive research has been devoted for decades to the development and validation of prognostic tools that may allow early and reliably discrimination between mild and severe disease. Numerous single markers (such as C-reactive protein (CRP), trypsin activation peptide (TAP), procalcitonin (PCT) and others) and complex scores (including the traditional Ranson, Glasgow and Acute Physiology …