Which etiology causes the most severe acute pancreatitis?

Background. The aim of the study was to define the prognostic role of etiology in the course of acute pancreatitis. Methods. The study involved 208 consecutive patients with a first attack of acute pancreatitis. Etiology was biliary in 81 (39%) patients and alcohol abuse in 69 (33%); other etiologies were present in 16 (8%), and etiology remained unknown in 42 (20%). Etiology was correlated with the following parameters of severity of the disease: days in an intensive care unit (ICU); total hospital stay (THS); Ranson, Imrie, and Balthazar scores (contrast-enhanced computed tomography [CT] within 72 h of admission); indication of artificial ventilation, dialysis, or surgery; development of pancreatic pseudocysts; mortality. Results. Alcoholic etiology correlated significantly more frequently than other subgroups with necrotizing pancreatitis, need for artificial ventilation, and development of pancreatic pseudocysts. For the other parameters, there were no significant differences between the etiologies. Conclusion. Patients with alcohol-induced acute pancreatitis should be given special attention because of the higher incidence of necrotizing pancreatitis and necessity for artificial ventilation. Whether the pronounced frequency of pseudocysts in alcoholics suggests progression to chronic pancreatitis has to be clarified in follow-up studies.