Evaluation of Laboratory Findings and Mortality in Elderly Patients with Acute Biliary Pancreatitis

Objectives: Gallstones are the most common cause of acute biliary pancreatitis. Laboratory and imaging findings as well as age are important predictors for mortality. Hospitalization rate is also higher in elderly patients. In this study, we investigated clinical parameters and total mortality in patients with acute pancreatitis aged >65 years.
Methods: In this study, 852 patients who entered the Gastroenterology Clinic for acute biliary pancreatitis between April 2006 and October 2013 were included. Data were retrospectively collected from the electronic record system. The patients with elevated aspartate aminotransferase levels (i.e. three times higher than normal value), cholelithiasis, cholecystectomy history, or choledocholithiasis were accepted as the patients with acute biliary pancreatitis. Patients were divided into two groups based on their age, i.e., >65 and <65 years.
Results: In the group with patients aged <65 years, serum alanine aminotransferase, albumin, hematocrit, and amylase, and in the group with patients aged >65 years, urea, leukocyte, and C-reactive protein levels were significantly different. Median hospital stay was similar in both the groups. The rate of detection of choledocholithiasis was significantly higher in elderly patients (p<0.001). Mortality rate was significantly higher in elderly patients for 28 day (0.21% and 2.95%, p<0.001) and 90 day (1.25% and 5.63%, p<0.001). In logistic regression multivariate analysis, age (OR 2.0, 95% CI 1.54–1.36; p=0.006), elevated urea levels (OR 1.12, 95% CI 1.05–1.19; p=0.001), elevated hematocrit levels (OR 1.42, 95% CI 1.13–1.77; p=0.002), and decreased albumin levels (OR 0.05, 95% CI 0.004–0.652; p=0.022) were found predictors for 90-day mortality.
Conclusion: Laboratory findings in elderly patients with acute pancreatitis may differ from those in younger patients. Although radiological findings are similar in both the groups, mortality is higher in the group with patients aged >65 years.

Akut biliyer pankreatitli geriatrik hastalarýn deðerlendirilmesi

Giriþ: Akut pankreatitin (AP) en sýk nedeni safra taþlarýdýr. AP’de laboratuvar, görüntüleme tetkikleri yanýnda yaþ da mortaliteyi göstermede önemli bir prediktördür. Yaþ artýþý ile birlikte hastaneye yatýþ oranýnýn da arttýðý görülmektedir. Bu çalýþmada akut biliyer pankreatitli 65 yaþ üstü hastalarda baþvuru bulgularý ve toplam mortalite araþtýrýldý.
Materyal-metod: Çalýþmaya Nisan 2006 - Ekim 2013 yýllarý arasýnda, Gastroenteroloji kliniðine baþvuran ve yatarak tedavi görmüþ olan toplam 852 hasta alýndý. Hastalarýn elektronik kayýt sisteminden verileri alýnarak retrospektif olarak deðerlendirildi. AST deðeri 3 kattan fazla yükselen, kolelitiazis olan, kolesistektomi öyküsü olan ya da koledokta taþ saptanan hastalar biliyer pankreatit olarak kabul edildi. Hastalar 65 yaþ üstü ve altýnda olmak üzere iki gruba ayrýldý.
Bulgular: Gençlerde ALT, albumin, hematokrit ve amilaz düzeyleri, yaþlýlarda ise üre, lökosit ve CRP düzeyi anlamlý olarak daha yüksek saptandý. Ortalama yatýþ süresi iki grupta da benzer bulundu. Yaþlýlarda koledokta taþ saptanma oranýnýn anlamlý olarak daha fazla olduðu görüldü (p<0.001). Mortalite oranlarý 65 yaþ üstü hastalarda 65 yaþ altý gruba göre 28. gün ve 90. günde (1.25% & 5.63%, p<0.001) anlamlý olarak daha fazla bulundu. Ayrýca lojistik regresyon çok deðiþkenli analizde, 90. gün mortaliteyi ön görmede yaþ (OR 2.0, 95% CI 1.54-1.36; p=0.006), üre (OR 1.12, 95% CI 1.05-1.19; p=0.001), hematokrit artmasý (OR 1.42, 95% CI 1.13-1.77; p=0.002) ve albumin azalmasýnýn (OR 0.05, 95% CI 0.004-0.652; p=0.022) mortalite için prediktör olduðu görüldü.
Sonuç: Yaþlý hastalarda AP’deki laboratuvar bulgularý 65 yaþ altýndaki hastalara göre farklýlýk gösterebilmektedir. Kesitsel görüntüleme bulgularý ise her iki grupta benzer olmasýna raðmen 65 yaþ üstü hastalarda mortalite daha yüksektir.