BACKGROUND To investigate the clinical characteristics of hypertriglyceridemia pancreatitis (HTGP) and evaluate the correlative risk factors for severe acute pancreatitis (SAP) in HTGP patients. MATERIAL AND METHODS A total of 1005 patients with acute pancreatitis (AP) admitted to Peking Union Medical College Hospital (PUMCH) from 1 Jan 2013 to 1 Aug 2018 were retrospectively reviewed. After screening, we enrolled 159 patients with HTGP and 172 with non-hypertriglyceridemia pancreatitis (NHTGP). We gathered and assessed demographic and blood biochemical information and analyzed the risk factors for SAP. RESULTS Age, serum amylase (AMY), lipase (LIP), and serum ionized calcium (Ca²⁺) in the HTGP group were lower than in the NHTGP group (P<0.05), while high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and body mass index (BMI) in the HTGP group were higher than in the NHTGP group (P<0.05). Among the HTGP patients, the results indicated that Ca²⁺ (OR=0.018, P<0.001, 95%CI: 0.002-0.129) was an independent protective factor for SAP, while higher CRP (OR=1.008, P=0.004, 95%CI: 1.003-1.013), NLR (OR=1.314, P<0.001, 95%CI: 1.161-1.488), and BMI (OR=1.597, P=0.002, 95%CI: 1.195-2.314) were independent risk factors for SAP. CONCLUSIONS Patients with HTGP had lower serum Ca²⁺ and higher hsCRP, NLR, and BMI, and these were associated with higher risk of developing SAP.