such as necrosis (8.8%, 11.0%, 11.5%), development of pseudocyst (9.0%, 9.2%, 13.3%) and fluid collection (28.3%, 31.3%, 35.5%). The percentage of moderate AP copied the same pattern (24.9%, 26.8% and 31.9%). We could see no difference in mortality and the rate of severe AP. Drinking and smoking together also elevate the risk for acute recurrent pancreatitis (ARP). 18.9% of the patients had ARP in the ND-NS, 23.5% in the D-NS, whereas 31.9% in the D-S groups. Conclusion Drinking and smoking together results in the onset of pancreatitis 15 years earlier, in addition it elevates the risk for recurrence of the disease. Drinking and smoking synergize with each other and in- crease the rate of local complications. P2-009. Clinical importance of extent and location of pancreatic necrosis in acute pancreatitis Povilas Ignatavicius, Inga Dekeryte, Tomas Jankus, Kristina Zviniene, Edita Bieliuniene, Giedrius Barauskas, Zilvinas Dambrauskas Lithuanian University of Health Sciences, Surgery, Kaunas, Lithuania Objectives To determine the clinical importance of the extent and location of peri/pancreatic necrosis in patients with AP. Methods Retrospective review of patients diagnosed with necrotizing AP who were treated from 2010 to 2016 at Hospital of Lithuanian Uni- versity of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (< 30%, 30-50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. Results The study included 83 patients (75.9% males (n¼63)) with a mean age of 53±1.7. Location and extent of necrosis were identified by contrast enhanced computed tomography. There were 22 patients (26.5%) with less than 30%, 19 patients (22.9%) with 30-50% and 42 patients (50.6%) with more than 50% of pancreatic necrosis. Total pancreatic necrosis was diagnosed in 36 patients (43.4%), right part of pancreas e in 23 patients (27.7%) and left part of pancreas e in 24 patients (28.9%). Positive blood culture (n¼14 (87.5%)), multiple organ dysfunction syndrome (n¼17 (73.9%)) and incidences of respiratory failure (n¼19 (73.1%)) were signifi- cantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p< 0.05). Patients with >50% of necrosis were significantly (p<0.05) more often classified as moderately severe (n¼24 (41.4%)) and severe (n¼18 (72%)). Number of surgical operations (n¼18 (72%)) and ultrasound guided interventions (n¼26 (65%)) was also significantly higher. The were no dif- ferences in clinical course and outcomes when comparing location of the pancreatic necrosis. Except in the group of patients with total pancreatic necrosis incidences of renal insufficiency (n¼11 (64.7%)) and infected pancreatic necrosis (n¼19 (57.6%)) was significantly higher (p<0.05). Conclusion the clinical course and outcomes are worse in case of pancreatic necrosis exceeding 50%. Longer and more complex treatment for this group of patients might be needed. P2-010. Vicious metabolic cycle in acute pancreatitis: from clinical observa- tions to experimental confirmation Emese T oth 1, 2 , Zolt an Rumbus 3 ,L aszl o Pot o 4 ,  Aron Vincze 5 ,G abor Veres 6 ,L aszl o Czak o 1 , Em} oke Ol ah 3 , Katalin M arta 3 , Alexandra Mik o 3 , Zolt an Rakonczay, Jr. 7 , Zsolt Balla 7 ,J ozsef Kaszaki 8 , Imre F€ oldesi 9 ,J ozsef Mal eth 1,10,11 , Andr as Garami 12 ,P eter Hegyi 2, 3 1 University of Szeged, First Department of Medicine, Szeged, Hungary 2 University of Szeged, MTA-SZTE Momentum Translational Gastroenterology Research Group, Szeged, Hungary 3 University of P ecs, Institute for Translational Medicine/1st Department of Medicine, P ecs, Hungary 4 University of P ecs, Institute of Bioanalysis, Medical School, P ecs, Hungary 5 University of P ecs, Department of Gastroenterology, First Department of Medicine, P ecs, Hungary 6 Semmelweis University, First Department of Pediatrics, Budapest, Hungary 7 University of Szeged, Department of Pathophysiology, Szeged, Hungary 8 University of Szeged, Institute of Surgical Research, Szeged, Hungary 9 University of Szeged, Department of Laboratory Medicine, Szeged, Hungary 10 University of Szeged, Momentum Epithel Cell Signalling and Secretion Research Group, Hungarian Academy of Sciences, Szeged, Hungary 11 University of Szeged, Department of Public Health, Szeged, Hungary 12 University of P ecs, Department of Translational Medicine, First Department of Medicine, P ecs, Hungary Objectives Acute pancreatitis (AP) is often accompanied by alterations of acid-base balance, but how blood pH can influence the outcome of AP is largely unknown. We aimed to find an association between blood pH and the outcome of AP with meta-analysis of clinical trials, and then to discover a causative relationship between blood pH and AP in experi- mental animals. Methods PubMed, EMBASE, and Cochrane Controlled Trials Registry databases were searched from inception to January 2017. Human studies reporting systemic pH status and outcomes (mortality rate, severity scores, and length of hospital stay) of patient groups with AP were included in the analyses. We developed a new mouse model of chronic metabolic acidosis (MA) and induced mild or severe AP in the mice Mild acute pancreatitis (MAP) was induced by alcohol and fatty acid as described earlier. Severe acute pancreatitis (SAP) was induced by the injections of cerulein (50 mg/ kg, i.p.) at start time, and then at every hour for 9 hours. In the chronic MA model, MAP and SAP were induced on day 12 of the acidifying treatment. Serum amylase activity was measured by using a colorimetric kinetic method . Serum concentrations of creatinin and glucose were measured with commercially available laboratory kits . Arterial blood samples were collected in sealed plastic capillaries (170 ml), which were previously treated with lithium and heparin. Analysis of the arterial blood samples was performed by a blood gas analyzer. Results Twelve studies reported sufficient data in patient groups with AP (n ¼ 2,311). Forest plot analyses revealed higher mortality (47.8 vs. 2.2%), elevated severity scores, and longer hospital stay in the AP patient groups with lower blood pH or base excess. Meta-regression analysis showed sig- nificant negative correlation between blood pH and mortality in AP. In our mouse model, MA deteriorated the pancreatic damage in mild and severe AP and, vice versa, severe AP further decreased the blood pH of mice with MA. Conclusion A vicious cycle between blood pH and AP exists, in which MA worsens the outcome of AP, while severe AP augments the lowering of blood pH. Our study revealed that, bigger acidic load is associated with worse clinical scores, longer hospital stay, and higher mortality rates in patients with AP. Also in this study, a novel mouse model of metabolic acidosis (MA) was developed. Severe AP augments the manifestation of MA and, vice versa, MA worsens the severity of AP in mice. P2-011. The value of APACHE II in predicting severity, mortality and duration of hospital treatment in the Montenegrin population with Acute pancreatitis e Experience of the Clinical center of Montenegro Rade Boricic, Brigita Smolovic, Milos Lukic Clinical Center of Montenegro, Internal Clinic, Podgorica, Montenegro Abstracts / Pancreatology 18 (2018) S1eS188 S13