The aim of this retrospective study was to determine characteristic features of the onset and the course of the most severe forms of a severe acute pancreatitis with a concomittent multiorgan dysfunction syndrome. The study included patients transferred to the Intensive Care with a severe acute pancreatitis diagnosis and with a respiratory, circulatory and renal insufficiency or coagulopathy, or with the combination of the above. During the period from VII/1997 to XII/2002, 23 patients were treated. The mortality rate reached 78%. The average APACHE II score on admission was 23 in survivors, and 27 in no-survivors. Continuously high SOFA score (p < 0.05), more significant circulatory instability during the first days of the treatment, expressed by a higher need for the adrenaline use, and continuously increased CRP values during the follow-up treatment (day 7–14, p < 0.05), all of it signalized unfavourable results. In 50% of the fatal cases, renal insuficiency, requiring the use of the extracorporeal elimination method was reported while, on the other hand, none of the survivors suffered from renal insufficiency. The unfavourable course of the condition was also characterized by a need for more intensive therapies: those, who exited, had been cathetrized more often and they had requiredmore surgical interventions. A favourable turn in the course of the disease was signalized by a drop in the serum CRP and by a decreasing need for vasopressors medication.

        Key words: acute pancreatitis – multiorgan dysfunction syndrome – intensive medical care – extracorporeal eliminating methods