To retrospectively analyze the risk factors for mortality in patients with severe acute pancreatitis (SAP), construct a prognostic analysis model, and further provide reference for the clinical diagnosis and treatment of SAP.

A total of 88 SAP patients who received treatment at the Department of Intensive Care Unit of the Second Hospital of Dalian Medical University from September 2017 to September 2022 were selected as the study subjects. Based on their survival status at one month after discharge, they were divided into a survival group (51 cases) and a death group (37 cases). The clinical data of patients in the two groups were compared, and multivariate logistic regression analysis was used to explore the risk factors of SAP mortality and construct a SAP risk assessment model. The accuracy of the model was evaluated using the receiver operating characteristic (ROC) curve and area under the curve.

There were statistically significant differences between the two groups in terms of the blood creatinine, blood urea nitrogen, blood amylase, blood lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), early enteral nutrition, liquid negative balance therapy, treatment with sivelestat sodium, total hospital stay, ICU stay, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment (SOFA) score, modified CT score and modified Marshall score (all P < 0.05). Further multivariate logistic regression analysis revealed that liquid negative balance therapy [odds ratio (OR) = 0.045, 95% confidence interval (CI) (0.003, 0.722), P = 0.029] was a protective factor for mortality in SAP patients, while modified CT scores [OR = 2.393, 95%CI (1.021, 5.609), P = 0.045] and modified Marshall scores [OR = 2.992, 95%CI (1.105, 9.194), P = 0.014] were risk factors. The prediction accuracy of the regression model was 94.4% for survival and 90.3% for death, and the overall prediction accuracy was 92.5%. The ROC curve analysis showed that the area under the curve was 0.978, with a 95%CI of 0.949-1.000 (P < 0.001).

The modified CT score and modified Marshall score are risk factors for mortality in SAP patients. Negative balance of fluid plan is a protective factor for SAP, which can reduce the mortality rate. The constructed SAP prognostic model can effectively conduct risk assessment.