BACKGROUND: Though acute respiratory distress(ARDS) often occurs in the early stage of severe acute pancreatitis and significantly contributed to the mortality of the condition, the characteristics of the group who develops ARDS in the patients with acute pancreatitis have not been fully found. The objective of this investigation was to identify predictable factors which distinguish a group who would develop ARDS in the patients with acute pancreatitis METHODS: A retrospective analysis of 94 cases in 86 patients who were admitted the Medical Intensive Care Unit with acute pancreatitis was done ARDS were developed in 3 cases among them (13.8%). The possible clinical factors related to the development were analyzed using univariate analysis and X(2)-test. RESULTS: The risk of ARDS development was increased in the patients with abonormal findings of chest X-ray at admission compared to the patients with normal chest X-ray (P<0.05). The risk was also increased according to the sevecrity index score in abdominal computed tomography at the time of admission (p<0.05). The higher APACHE III score of the first day of admission, the more risk increment of ARDS development was observed (p<0.01). Patients with more than one points of Murray's lung injury score showed higher risk of ARDS compared to the patients with 0 points of that. The patients with sepsis and the patients with more than three organ dysfunction at admission had 3.5 times and 23.3 times higher risk of the development, of ARDS compared to the patients without sepsis and without organ failure in each (p<0.05, p<0.01). CONCLUSION: The risk of ARDS development would k higher in the acute pancreatitis patients with abnormal chest X-ray, higher CT severity index, higher APACHE HI or Murray's lung injury score, accompanying sepsis, and more than three organ failure at admission