Acute pancreatitis affects around 56/100,000 population in the UK.1 The majority of patients present with an acute disease process that resolves quickly and leaves no lasting effects. For approximately 25%, however, critical care support is required for organ dysfunction, and in this cohort hospital mortality approaches 25%.2 As a multi-system disease process, complications can be widespread and varied and, in those requiring critical care, admissions are often protracted. It is for these reasons an appreciation of identifying those most at risk of severe acute pancreatitis (SAP) is vital, as this can allow early optimization of physiology potentially reducing the risk of progressive organ failure.