Acute pancreatitis (AP) is a disease that poses significant health risks with potential severe outcomes. Identifying markers for severity can aid in early intervention and improve prognoses. This study, conducted in the emergency department, investigates the QRS–T angle as a potential indicator of severity in patients with acute pancreatitis. This retrospective study included 367 patients diagnosed with AP, classified as either mild acute pancreatitis or severe acute pancreatitis based on Ranson criteria. The QRS–T angle was measured using standard 12-lead electrocardiogram, and the data were analyzed to compare the QRS–T angles between the mild acute pancreatitis and severe acute pancreatitis groups. This research adhered to the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology statement. The study included 367 patients, 94% (n = 345) had mild pancreatitis while 6% (n = 22) had severe pancreatitis. Severe cases had a significantly higher median age (P < .001) and higher rates of hypertension and diabetes mellitus (P = .027, P = .011). Severe cases also had higher Ranson scores (3 [IQR 3–3.25] vs 1 [IQR 1–2], P < .001) and longer hospital stays (6 [IQR 2.75–11.5] days vs 3 [2–5] days, P = .029). Additionally, severe pancreatitis group showed higher QRS–T angle (P < .001), higher rates of abnormal QRS angles (31.8% vs 10.1%, P = .002), and QRS–T angles (31.8% vs 8.1%, P < .001). The QRS–T angle may serve as a valuable clinical tool for differentiating between mild and severe forms of acute pancreatitis. This could potentially help clinicians in stratifying patients according to their risk and tailoring their management accordingly.