Clinical Predictors of Severe Acute Pancreatitis: A Retrospective Cohort Study in Hebron City, Palestine

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency with a wide spectrum of severity. While many predictive scoring systems exist, early clinical predictors remain essential for guiding management, especially in resource-limited settings. There is limited evidence describing the etiological profile and clinical predictors of severity in the Palestinian population. To identify the etiological distribution of AP and determine clinical predictors associated with severe disease among patients admitted in Hebron, Palestine. Methods: A retrospective cohort study was conducted including 316 patients diagnosed with AP across two major hospitals in Hebron between 2019 and 2024. Severity was classified using the APACHE II scoring system (Mild: 0–7; Moderate: 8–14; Severe: ≥15). Etiology, age category, and comorbidity status were recorded. Bivariable and multivariable logistic regression analyses were used to identify predictors of severe AP. Results : Gallstones were the most common etiology (40.8%), followed by idiopathic (20.3%), hypertriglyceridemia (17.4%), and post-ERCP pancreatitis (11.4%). Only 2.2% of cases were alcohol-related. Overall, 21.2% of patients developed severe pancreatitis. Patients with comorbidities had a significantly higher proportion of severe disease compared to those without (36.7% vs. 14.2%, p < 0.001). In multivariable regression, comorbidity remained a strong independent predictor of severe AP (Adjusted OR 2.62, 95% CI 1.32–5.20, p = 0.006). Etiology did not independently predict severity after adjustment ( p = 0.055), though hypercalcemia and hypertriglyceridemia showed notable descriptive trends toward more severe disease. Conclusions: Gallstones are the leading cause of acute pancreatitis in Hebron, while alcohol-induced pancreatitis is rare. The presence of comorbid illness is an important and independent predictor of severe disease. Early recognition and closer monitoring of patients with comorbidities may improve outcomes. Larger prospective studies are needed to further clarify the influence of etiological subtypes on disease severity.