Objective: To analyze prognostic factors in patients with severe acute pancreatitis. Methods: Retrospective cohort of 64 consecutive patients with the diagnosis of severe acute pancreatitis defined as APACHE II > 8 or Ranson > 3 seen at Fundacion Valle del Lili, Cali, Colombia, in the period 1995-2004. Demographic, clinical and surgical data were analyzed. Results: In the series of 64 patients, the most common etiology was cholelithiasis (51.6%). The median APACHE II score was 13. Average stay in the ICU was 16 ± 14.8 days (rank 1-63), total hospital stay was 28.1 ± 19.8 days (1-84); 82.8 % of patients were operated on, with an average number of repeat laparotomies of 4.2 ± 4.4 (1-18); 81.3% developed necrosis, infected or abscess = 84.9%, and sterile = 26.4%, with 81.3% of patients receiving antibiotics during 14 days. Positive cultures from abdomen were found in 60.9%, with Enterococcus fecalis and Staphylococcus aureus being the most commonly encountered organisms. The global mortality rate was 21.5% and the mortality rate in severe acute infected necrotizing pancreatitis was 28.9%. Factors associated with mortality were: ARDS (5.98%, IC 95% 1.3-31, p 20 (16.2, 3.2-37.9, p 20 were predictors of death (OR: 31.25, 2.7-345, and OR: 1,27, 1.07-1.51, respectively, p <0.05). Conclusion: The presence of shock and the APACHE II score appeared as independent predictive factors of death. Global mortality and mortality of severe acute infected necrotizing pancreatitis were low: 21.5% and 28.9% respectively.