Update on the effect of age on acute pancreatitis morbidity: a retrospective, single-center study

Abstract

IntroductionAcute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing.AimTo evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients.Material and methodsWe retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015.ResultsOf the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001).ConclusionsAcute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.

Acute Pancreatitis in Elderly Patients

“…AP has been found in 52% of individuals aged >55 years, in 55.6% of those aged > 60 years, from 20.3% to 47.8% of those aged > 65 years, from 35.8% to 50% of those aged > 70 years, and from 12% to 18% in individuals over age 80 years. [2][3][4][5][6][7][8][9][10][11][12][13] Biliary lithiasis is the most frequent cause in these population (39.3%-70%). 2,4,5,7,10,12 Lithogenic bile, delayed gallbladder emptying, and dilation of the bile duct may favor the development of AP in older people.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13] Biliary lithiasis is the most frequent cause in these population (39.3%-70%). 2,4,5,7,10,12 Lithogenic bile, delayed gallbladder emptying, and dilation of the bile duct may favor the development of AP in older people. 12 Biliary AP is significantly more frequent in the elderly compared with younger patients (56.4%-64.9% vs 20.2%-37.3%).…”

“…2,5,7 Alcohol toxicity is the second most common cause followed by the idiopathic pancreatitis (14.3%-31% of cases). 2,3,5,[10][11][12] Idiopathic AP may include diverse causes such as genetic polymorphisms, smoking, environmental toxins, and other comorbidities typically observed in aging. 4 Drug intake appeared to be the cause of AP in around 10% because of polypharmacy.…”

“…1 Fever and leukocytosis are often absent, and a confusional state with rapid development of shock may be found. The elderly also show more frequently increased serum creatinine levels 10 and decreased serum albumin and hemoglobin levels. 10,12 Furthermore, AP may be clinically indistinguishable from other intra-abdominal conditions with similar clinical features and serum amylase enzyme elevations, including mesenteric ischemia, acute biliary disease, and perforated peptic ulcer.…”

Acute pancreatitis and the weekend effect: does weekend admission affect patient outcome?

“…There is little known at this time, however, on the weekend effect on AP specifically, even though the incidence of the condition has increased during the past 20 years [ 13 , 14 ]. Two recent retrospective studies evaluated the differences in outcome for AP patients admitted during the week versus those admitted on a weekend and found no increased in-hospital mortality between the two groups, suggesting there is no weekend effect when treating AP [ 15 , 16 ].…”