Elderly persons with acute pancreatitis – specifics of the clinical course of the disease

Abstract

Background: As may readily be inferred from clinical observations, there is an increasing prevalence of severe acute pancreatitis (SAP) in the elderly, even though the precise nature of the relationship between a patient’s age and severity of the disease has not been unequivocally determined to date. This study aimed therefore to investigate the incidence, clinical course, and mortality rate among the elderly patients suffering from acute pancreatitis (AP), as compared to younger ones. Methods: A prospective study, lasting a single calendar year, covered patients with AP successively admitted to hospitals. The final assessment comprised 963 patients. The patients were subsequently divided into three groups corresponding to the three grades of disease severity, based on the Revised Atlanta Classification for Acute Pancreatitis. The actual cause of the disease, its clinical course, results of radiological ultrasonography, computed tomography, and laboratory tests, as well as the duration of hospital stay were assessed in due consideration of patients’ age (groups aged 65–79 years and ≥80 years vs <65 years). Results: Cholelithiasis was determined as the main cause of AP among the older patients (54.08% and 58.12% vs 22.46%; P<0.000). Among the oldest patients (≥80 years), its course was often significantly more severe, in comparison with the ones under 65 years of age: 14.53% vs 6.31% (P<0.00); a phenomenon not observed in the age range 65–79 years, nor among the younger patients (7.69% vs 6.31%; P>0.05). Moderate AP occurred significantly more often in the younger patients compared to those aged ≥80 years (16% vs 8.55%; P<0.00), although without any significant differences observed between the group aged 65–79 years and the younger patients (13.27% vs 8.55%). SAP more frequently ended in death among the oldest patients – 11.97% vs 2.31% (P<0.000) than in the group aged 65–79 years (4.59%), as compared to the younger groups (P>0.05). Conclusion: An appreciably higher susceptibility of older patients aged ≥80 years to AP, with cholelithiasis being the main cause that results in high mortality rate, is presently acknowledged a serious diagnostic and therapeutic management challenge to a national healthcare system.