Acute pancreatitis in elderly patients: A retrospective evaluation at hospital admission

Background and aims Acute pancreatitis (AP) in elderly may have an aggressive course due to co-morbidity high rate and severe presentation. We retrospectively evaluated AP severity and its underlying factors in a group of elderly patients compared with an adult population sample. Methods Forty-two elderly patients (65-102 years) and 48 controls (19-64 years) admitted at our Unit for biliary or alcoholic AP were retrospectively enrolled. AP severity was evaluated by the Atlanta classification and Ransom score. Laboratory investigations and demographic data were collected. Comparison between the two groups was performed by t-test, ANOVA or Fisher's exact test. A multinomial logistic regression was used to determine factors affecting AP severity. Results Elderly patients showed more severe Atlanta (1.81 ± 0.75 vs 1.29 ± 0.46; p = 0.007) and higher Ransom (2.52 ± 1.57 vs 0.75 ± 0.73; p < 0.0001) scores. No death was observed. Elderly patients consumed more drugs than controls, had higher rates of cardiovascular, pulmonary and renal co-morbidity, showed higher creatinine (1.09 ± 0.41 vs 0.81 ± 0.18; p = 0.004) and lower calcium levels (8.43 ± 0.48 vs 8.88 ± 0.44; p = 0.002). We observed only one case of fluid necrosis in an old patient. Non-necrotic fluid collections were more common in the elderly (40.5% vs 12.5%; p = 0.003). At multivariate analysis, AP severity was influenced by white blood cell-count (WBC: OR = 1.94; p = 0.048), aspartate-transaminase-levels (AST: OR = 1.97; p = 0.02), serum lactate-dehydrogenase (LDH: OR = 1.07; p = 0.047) and Ransom score (OR = 70.4; p = 0.036) in elderly, while only Ransom score correlated in controls (OR = 66.04; p < 0.001). The etiology (biliary/alcoholic) did not influence the severity. Conclusions Elderly patients usually undergo a severe AP course, but without increase of mortality. High WBC, LDH, AST and Ransom score at the onset may predict AP severity.