Abstract: Objective To investigate the clinical characteristics, prognosis effects and management of different admission serum glucose levels in patients with severe acute pancreatitis (SAP). Methods A retrospective analysis involving a total of 218 patients with SAP and have seru m glucose ≥6.1 mmol/L at admission during the period from August 1, 2005 to Dec ember 31, 2007 was enrolled based on the coding data in West China hospital. The y were divided into 3 groups according to admission glucose levels of 6.1-11.1 mmol/L (n=115), 11.2-16.7 mmol/L (n=71), and >16.7 mmol/L (n=32) r espe ctively. Patients’ demographic characteristics, cl inical parameters, various scoring systems, the ICU transfer rate during early p hase and the mortality, infection rate and operation transfer rate during later phase were obtained and calculated. Results The pulse and resp ire frequency, the levels of serum lactate dehydrogenase (LDH), blood urea nitro gen (BUN), creatinine (Crea) and scores on the Ranson Criteria, Acute Physiology and Chronic Healt h Evaluation Ⅱ (APACHE Ⅱ) at admission, APACHE Ⅱ and Balthazar’s Computed To mography Severity Index (CTSI) within 72 hours increased in sequence according t o mild, moderate and severe hyperglycemic group (P<0.01). Whereas the concen tration of serum Ca²⁺ was lower than that in the mild elevated serum gluco se group (P<0.01). In the 3 groups, the early single organ failure rates wer e elevated in turn (P<0.01) and the multi-organ failure rates were 16.5%, 4 5.1% and 50.0% (P<0.01) respectively. Simultaneously, the ICU transfer rate s were 10.4%, 26.8% and 34.4%, while the mortality in the 3 groups were 7.8%, 16 .9% and 40.6% respectively, which were statistically significant (P<0.01) .Conclusion The findings of the study suggest that admission elevate d glucose is an indicator of organ failure and poor prognosis of SAP.