Objective To investigate the predictive value of early phase intra-abdominal pressure (IAP) for severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI). Methods A total of 60 SAP patients were enrolled in this study who were treated in the Intensive Care Unit of the Emergency Department in our hospital from January 2016 to September 2017. The patients were divided into intra-abdominal hypertension (IAH) group and non-intra-abdominal hypertension (non-IAH) group, depending on whether 2 consecutive IAP measurements were higher than 12 mmHg (1 mmHg=0.133 kPa) within 72 h after admission. The 2 groups were then compared in the baseline data, incidence of AKI and proportion of continuous renal replacement therapy (CRRT). Receiver operating characteristic (ROC) curve was employed to analyze the predictive value of IAP in the early phase of SAP for AKI. SPSS statistics 17.0 was used for analysis. Student′s t test or Chi-square test was conducted for the comparison according to the data type. Results The IAH group had significantly higher readings than the non-IAH group in tumor necrosis factor-ɑ [(2.30±0.79) vs (1.88±0.55)mg/ml,P=0.04] and interleukin-6 [(217.04±77.16) vs (178.86±60.93)ng/L, P=0.02], and the difference was statistically significant. AKI [45.8%(11/24) vs 16.7%(6/36), P=0.02] and CRRT [29.2%(7/24) vs 5.6%(2/36), P=0.02] were significantly higher in the former than in the latter. The area under ROC curve was 0.728 (OR=4.231,5%CI 1.289-13.889, P<0.05) for IAP in the early phase of SAP in predicting AKI; the cut-off point of the IAP in the early phase of SAP was 12 mmHg with a sensitivity of 82.4% and a specificity of 34.9% and had a moderate accuracy. Conclusion Elevated IAP in the early phase of SAP has predictive value for AKI and can be used to assess the risk of AKI.