medRxiv (Medicine)
2026-06-23
DOI: HASH:b5f7a037a31b4cf9728c19c5d0d42190
**Background:** Acute pancreatitis (AP) is a common gastrointestinal emergency with a subset of patients progressing to severe acute pancreatitis (SAP), which carries substantial morbidity and mortality. Current clinical severity scores such as BISAP, APACHE II, Ranson, and the Modified CT Severity Index require upon 48 hours of observation before reliable assessment is possible, limiting early triage. Machine learning (ML) approaches using routine admission laboratory values may enable earlier, more accurate prediction. **Methods:** We evaluated 11 models spanning three architectural families classical ML (Logistic Regression, Random Forest, Gradient Boosting), feedforward deep learning (MLP, Residual MLP, Attention MLP), and recurrent deep learning (LSTM, Stacked LSTM, Bidirectional LSTM, LSTM+Attention, CNN-LSTM) on a Chinese AP cohort of 722 patients (585 severe, 137 mild) labelled according to the 2012 Revised Atlanta Classification. Performance was assessed via 5-fold stratified cross-validation using AUC-ROC, F1 score, sensitivity, specificity, and PPV, with decision thresholds optimised for maximal F1. **Results:** Random Forest achieved the highest AUC of 0.877 (F1=0.917, sensitivity=96.8%, PPV=87.1%), followed closely by Gradient Boosting (AUC=0.874, F1=0.918). Classical ML models consistently outperformed deep learning counterparts. CNN-LSTM was the best recurrent model (AUC=0.777) but remained inferior to all classical approaches. LSTM-family models produced AUC values of 0.684-0.777, reflecting the cross-sectional tabular nature of the data. **Conclusions:** Random Forest provides robust, high-sensitivity early prediction of SAP severity using routine admission data. External prospective validation is required before clinical deployment. **Keywords:** acute pancreatitis; severity prediction; machine learning; random forest; deep learning; LSTM; Revised Atlanta Classification; early triage