Objective: To analyze the changes and significance of serum lipoxide A4 (LXA4), neutrophil gelatinase-related lipid carrier protein (NGAL) and procalcitonin (PCT) in patients with acute pancreatitis (AP). Methods: A total of 95 AP patients were divided into 57 cases of mild acute pancreatitis (MAP) group and 38 cases of severe acute pancreatitis (SAP) group according to the disease degree, according to the hospital clinical outcome were divided into a survival group (77 cases) and a death group (18 cases); at the same time, we chose 76 cases of outpatient health physical examination as a control group. Serum levels of LXA4, NGAL and PCT of each group were compared, to analyze the prognostic value of the above indicators for AP patients. Results: Serum level of LXA4 in AP group was lower than that in control group on day 1, 3 and 7, and levels of NGAL and PCT were higher than those in control group (P<0.05). Serum level of LXA4 in MAP group was higher than that in SAP group, and serum levels of NGAL and PCT were lower than those in SAP group (P<0.05). Serum level of LXA4 gradually increased and serum levels of NGAL and PCT gradually decreased in the MAP group and SAP group on day 3 and 7 after admission (P<0.05). On the first day of admission, serum level of LXA4 in the survival group was higher than that in the death group, and serum levels of NGAL and PCT were lower than that in the death group (P<0.05). The area under the receiver operating characteristic (ROC) curve predicted by LXA4 for the prognosis of AP patients was 0.755, NGAL was 0.830, PCT was 0.864, LXA4+NGAL+PCT was 0.944, and the area under the curve (AUC) predicted by LXA4+NGAL+PCT was higher than the single index. Conclusion: Serum LXA4, NGAL and PCT can effectively reflect the disease status and prognosis of AP, and provide a basis for clinical individualized treatment of such patients.