The Impact of Age Over 80 Years on Outcomes in Geriatric Patients with Acute Pancreatitis: A Single Center Experience

Year 2024, Volume: 46 Issue: 2, 284 - 292, 18.03.2024

Hakan Şıvgın , Abdurrahman Şahin

https://doi.org/10.20515/otd.1415422

Abstract

The aim of this study is to evaluate the prognosis and mortality of acute pancreatitis (AP) in older subjects and compare octogenarians (≥80 years) with nonoctogenarians (age <80 years). The medical records of elderly patients who were followed up with the diagnosis of AP at our clinic between January 2018 and December 2021 were retrospectively analyzed. The etiology of AP, comorbidities, laboratory parameters, intensive care unit (ICU) admission, and mortality were noted. Among survivors, one-year mortality status was also recorded. Disease severity, in-hospital mortality and one-year mortality were compared. A total of 206 older patients (60 octogenarian, 146 nonoctogenariean) were recruited to the study. Of them, 115 (56%) were female and the mean age was 76.1±7.3 years. Severity of AP didn’t differ between octogenarians and nonctogenarians (p>0.05). ICU admission was seen in 13% of octogenarians and 11% of nonoctogenarians (p>0.05). In-hospital mortality occurred in 8.3% of octogenarians and 6.8% of nonoctogenarians (p>0.05). After discharge, one-year mortality occurred in 20% of octogenarians and 6.6% of nonoctogenarians (p<0.01). In multivariate analysis severe AP (OR:24.940;%95CI:1.013–95.609; p=0.01), ICU admission (OR:10.244;%95CI:1.399–74.990; p=0.01) and chronic kidney disease(CKD) (OR:9.840;%95CI:1.013–95.609; p=0.04) were independent risk factors for in-hospital mortality, and ≥80 years (OR:2.984;%95 CI:1.116–7.980; p =0.03) and neurological disorders (OR:4.424;%95CI:1.480–13.226; p <0.01) were independent factors related to one-year mortality. Our results showed that advenced age has not a significant effect on the course of AP in elderly. Comorbidities play important role in short- and long-term outcomes in elderly. Larger prospective trials are needed to draw more definitive conclusions.

Keywords

Acute pancreatitis, Elderly, Mortality, Octagenarians, Severity

Akut Pankreatitli Geriatrik Hastalarda 80 Yaş Üstü Olmanın Sonuçlar Üzerindeki Etkisi: Tek Merkez Deneyimi

Abstract

Bu çalışmanın amacı yaşlı bireylerde akut pankreatitin (AP) prognozunu ve mortalitesini değerlendirmek ve 80 yaş ve üzeri hastaları, 80 yaş altı hastalarla karşılaştırmaktır. Ocak 2018-Aralık 2021 tarihleri arasında kliniğimizde AP tanısı ile takip edilen yaşlı hastaların tıbbi kayıtları retrospektif olarak incelendi. Akut pankreatit nedeni, komorbiditeler, laboratuvar parametreleri, yoğun bakım ünitesine (YBÜ) yatış ve mortalite kaydedildi. Taburcu edilenlerde bir yıllık sağkalım durumu da kaydedildi. Akut pankreatit şiddeti, hastane mortalitesi ve bir yıllık mortalite karşılaştırıldı. Çalışmaya toplam 206 yaşlı hasta (60’ı 80 yaş üzeri, 146’sı 80 yaş altı) dahil edildi. Bunların 115'i (%56) kadındı ve yaş ortalaması 76.1±7.3 yıldı. AP şiddeti 80 yaş üzeri ve altı hastalar arasında farklılık göstermedi (p>0.05). YBÜ’nde yatış 80 yaş üzeri hastaların %13’ünde, 80 yaş altı hastaların %11’inde mevcuttu (p>0.05). Seksen yaş üzeri hastaların %8.3’ ünde, 80 yaş altı hastaların %6.8’inde hastane mortalitesi meydana geldi (p>0.05). Yaşayan hastalarda, taburculuk sonrası bir yıllık mortalite 80 yaş üzeri olanların %20’sinde ve 80 yaş altı olanların %6.6’ sında görüldü (p<0.01). Çok değişkenli analizde şiddetli AP (OR:24.940; %95CI:1.013–95.609; p=0.01), YBÜ yatışı (OR:10.244; %95CI:1.399–74.990; p=0.01) ve kronik böbrek hastalığı (KBH) (OR:9.840; %95CI:1.013–95.609; p=0.04) hastane mortalitesi için bağımsız risk faktörleriyken, 80 yaş üzeri olmak (OR: 2.984;%95 CI:1.116–7.980; p =0.03) ve nörolojik hastalıklar (OR:4.424;%95CI:1.480–13.226; p <0.01) bir yıllık mortaliteyle ilişkili bağımsız faktörlerdi. Sonuçlarımız ileri yaşın yaşlılarda AP seyri üzerinde belirgin bir etkisinin olmadığını gösterdi. Yaşlılarda, komorbiditeler kısa ve uzun dönem sonuçlarda önemli rol oynamaktadır. Daha kesin sonuçlara varmak için daha büyük prospektif çalışmalara ihtiyaç vardır.

Keywords

Akut pankreatit, Yaşlılar, Mortalite, Seksen Yaş Üzeri, Hastalık Şiddeti

References

• 1. https://data.tuik.gov.tr/Bulten/Index?p=Hayat-Tablolari-2020-2022-49726. (Access on: December 22, 2023)
• 2. Papapostolou S, Dinh DT, Noaman S, Biswas S, Duffy SJ, Stub D, et al. Effect of Age on Clinical Outcomes in Elderly Patients (>80 Years) Undergoing Percutaneous Coronary Intervention: Insights From a Multi-Centre Australian PCI Registry. Heart Lung Circ. 2021;30(7):1002-13.
• 3. Yu B, Li N, Li J, Wan J, He W, Zhu Y, et al. The Clinical Characteristics of Acute Pancreatitis in Gerontal Patients: A Retrospective Study. Clin Interv Aging. 2020;15:1541-53.
• 4. Nesvaderani M, Eslick GD, Vagg D, Faraj S, Cox MR. Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study. Int J Surg. 2015;23(Pt A):68-74.
• 5. Quero G, Covino M, Fiorillo C, Rosa F, Menghi R, Simeoni B, et al. Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes. Scand J Gastroenterol. 2019;54(4):492-8.
• 6. Baeza-Zapata AA, Garcia-Compean D, Jaquez-Quintana JO, Collaborators. Acute Pancreatitis in Elderly Patients. Gastroenterology. 2021;161(6):1736-40.
• 7. Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality. BMJ. 2004;328(7454):1466-9.
• 8. Koziel D, Gluszek-Osuch M, Suliga E, Zak M, Gluszek S. Elderly persons with acute pancreatitis - specifics of the clinical course of the disease. Clin Interv Aging. 2019;14:33-41.
• 9. Lee DW, Cho CM. Predicting Severity of Acute Pancreatitis. Medicina (Kaunas). 2022;58(6).
• 10. Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017;17(2):155-65.
• 11. Sahiner ES, Acehan F, Inan O, Aslan M, Altiparmak E, Ates I. Characteristics and clinical outcomes of patients over 80 years of age with acute pancreatitis. Eur Geriatr Med. 2022;13(4):1013-22.
• 12. Marta K, Lazarescu AM, Farkas N, Matrai P, Cazacu I, Ottoffy M, et al. Aging and Comorbidities in Acute Pancreatitis I: A Meta-Analysis and Systematic Review Based on 194,702 Patients. Front Physiol. 2019;10:328.
• 13. Patel K, Li F, Luthra A, Hinton A, Lara L, Groce R, et al. Acute Biliary Pancreatitis is Associated With Adverse Outcomes in the Elderly: A Propensity Score-Matched Analysis. J Clin Gastroenterol. 2019;53(7):e291-e7.
• 14. Carvalho JR, Fernandes SR, Santos P, Moura CM, Antunes T, Velosa J. Acute pancreatitis in the elderly: a cause for increased concern? Eur J Gastroenterol Hepatol. 2018;30(3):337-41.
• 15. Koksal AS, Tozlu M, Sezgin O, Oguz D, Kalkan IH, Altintas E, et al. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. Pancreatology. 2023.
• 16. Di Mauro D, Wijesurendere CN, Attanasio A, Fulgenzi CAM, Elkhuffash I, Ricciardi E, et al. Outcome of acute pancreatitis in octogenarians: A retrospective study. JGH Open. 2020;4(3):461-5.
• 17. Asfuroglu Kalkan E, Kalkan C, Kacar S, Barutcu S, Yuksel M, Gucbey Turker O, et al. Similarities and Differences Between Gerontal and Young Patients with Acute Pancreatitis: Evaluation of Clinical Characteristics and Outcomes. Turk J Gastroenterol. 2022;33(10):874-84.
• 18. Kayar Y, Dertli R, Konur S. Clinical outcomes of acute pancreatitis in elderly patients: An experience of single tertiary center. Pancreatology. 2020;20(7):1296-301.
• 19. Wajda J, Dumnicka P, Maraj M, Ceranowicz P, Kuzniewski M, Kusnierz-Cabala B. Potential Prognostic Markers of Acute Kidney Injury in the Early Phase of Acute Pancreatitis. Int J Mol Sci. 2019;20(15).
• 20. Mackenbach JP, Karanikolos M, Looman CW. The rise of mortality from mental and neurological diseases in Europe, 1979-2009: observational study. BMC Public Health. 2014;14:840.
• 21. Czira ME, Baune BT, Roesler A, Pfadenhauer K, Trenkwalder C, Berger K. Association between neurological disorders, functioning, and mortality in the elderly. Acta Neurol Scand. 2014;130(5):283-91.
• 22. Dumurgier J, Tzourio C. Epidemiology of neurological diseases in older adults. Rev Neurol (Paris). 2020;176(9):642-8.