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Aims. Serum lipid concentrations are known to react during acute disease. In this study, we sought to measure changes in the serum lipid profile during acute pancreatitis and whether these changes were associated with the severity of the disease. Methods. We analyzed 233 patients hospitalized for acute pancreatitis between 1995-1995. All etiologies of acute pancreatitis were included, as were patients with their first acute pancreatitis or recurrencies. Serum samples were obtained during the first days after admission and further follow-up samples were obtained later during the course of the disease. In most cases (n=203, 87%), samples were available from the first two days of hospitalization. The serum total cholesterol, HDL-cholesterol and triglyceride levels were measured enzymatically and the concentrations of serum LDL-cholesterol were calculated using the Friedewald formula. Results. The most common etiology for acute pancreatitis was alcohol use (n=131, 56%), followed by biliary (n=48, 21%) and idiopathic (n=36, 16%) pancreatitis. 64 (28%) patients had a severe pancreatitis, with 13 (6%) mortalities. Serum total cholesterol, HDL-cholesterol and LDL-cholesterol measured within 2 days of admission were significantly lower in patients with severe pancreatitis and associated with in-hospital mortalities and longer hospitalization (p<0.05). In subgroup analysis, the findings remained statistically significant in patients with alcohol induced acute pancreatitis, though were similar with all etiologies. Furthermore, these findings were evident even later during the course of the disease. Conclusions. Serum lipid concentrations react during acute pancreatitis. The levels of serum total cholesterol, HDL-cholesterol and LDL-cholesterol are significantly lower in patients with severe acute pancreatitis and are associated with in-hospital mortality and longer hospital stay. These changes are already present during the early stages of the disease and are similar in all etiologies of acute pancreatitis. Furthermore, the changes observed are present even later during the course of the disease. Further studies are needed to study the mechanisms of this association.