Comparative Analysis of Laboratory Markers, Severity Scores, and Outcomes in 179 Patients with Severe Acute Pancreatitis

<b>Background and Objectives</b>: Severe acute pancreatitis carries a substantial risk of complications and death. Prompt identification of prognostic factors is crucial to optimize management and reduce mortality. This study aims to compare inflammatory scores, laboratory markers, and clinical outcomes between survivors and non-survivors with severe acute pancreatitis, drawing on data from 179 patients admitted between 2017 and 2024. <b>Methods</b>: We conducted a retrospective cohort study of 179 patients diagnosed with severe acute pancreatitis. Of these, 55 patient records were extracted from an existing database, and an additional 124 were included from hospital archives (2017-2024). We divided participants into survivors (<i>n</i> = 121) and non-survivors (<i>n</i> = 58). Clinical data were obtained from medical records, including demographic information, comorbidities, laboratory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)), and severity scores (Acute Physiology and Chronic Health Evaluation (APACHE), Computed Tomography Severity Index (CTSI), and Ranson). <b>Results</b>: Non-survivors had significantly higher ages (mean of 66.4 vs. 52.7 years, <i>p</i> = 0.002), elevated inflammatory markers (median NLR of 14.2 vs. 10.3, <i>p</i> = 0.031), and more frequent multiorgan failure (75.9% vs. 31.4%, <i>p</i> < 0.001). The timing of intervention before 28 days was associated with higher mortality (<i>p</i> = 0.004). Chronic kidney disease and advanced cardiovascular comorbidities independently predicted worse survival (<i>p</i> = 0.009). The mortality rate in this cohort was 32.4%. Logistic regression identified age >60 years with an odds ratio (OR = 2.9), multiple organ failure (OR = 4.1), and high severity scores as primary contributors to mortality. <b>Conclusions</b>: Advanced age, comorbidities, elevated inflammatory markers, and multiple organ failure significantly impact mortality in severe acute pancreatitis. Delaying major interventions when feasible, optimizing perioperative care, and early recognition of high-risk patients may improve outcomes. Further research should explore targeted management strategies for high-risk groups and refine the role of delayed or minimally invasive approaches in severe acute pancreatitis management.