Other investigators have evaluated the utility of extrapancreatic changes as a diagnostic tool for early phase AP. Schroder et al have reported that extrapancreatic changes were more frequent in patients with hemorrhagic pancreatitis. Hjelmqvist et al reported similar findings, and they suggested that peripancreatic edema, retroperitoneal and intraperitoneal edema, bowel distension, and pleural effusion should be incorporated into the scoring system. However, the prognostic value of this score using receiver operator characteristic (ROC) curve analysis was never determined. In 2004, Mortele et al used a modified CTSI which included extrapancreatic findings such as pleural effusion, ascites, vascular or parenchymal complications, and gastrointestinal tract involvement. They found that this scoring system correlated with outcome parameters better than the commonly used CTSI. These studies indicated that extrapancreatic inflammation plays an important role in predicting the severity of AP. In 2007, De Waele et al developed a new unenhanced CT scoring system called the extrapancreatic inflammation on CT (EPIC) score, and they concluded that this scoring system allowed accurate estimation of disease severity and mortality within 24 hours of admission. They also found that an EPIC score of 4 or higher had an area under the curve (AUC) of 0.91 and had a sensitivity and specificity for predicting severe pancreatitis of 100% and 70.8%, respectively. However, they used the old 1992 Atlanta classification of AP that defined 2 degrees of severity: severe AP and mortality. According to the 2012 revised Atlanta classification of AP, 3 degrees of severity are defined: mild acute pancreatitis (absence of organ failure), moderately severe acute pancreatitis (presence of transient organ failure), and severe acute pancreatitis (presence of persistent organ failure). The purpose of this study was to evaluate the utility of the EPIC score for predicting organ failure in the early phase of AP as defined by the revised Atlanta classification.