Severe Acute Pancreatitis in Elderly Patients

Takahiro Nakajima, Takashi Ueda, Yoshifumi Takeyama*, Takeo Yasuda, Shinji Kishi, Hidehiro Sawa, Tetsuo Ajiki, Yasuhiro Fujino, Yasuyuki Suzuki and Yoshikazu Kuroda

Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences
Department of Surgery, Kinki University School of Medicine*

Purpose: Because severe acute pancreatitis (SAP) is increasing among elderly patients, we clarified SAP characteristics. Methods: We divided 137 patients with SAP into a high age group (32 patients 67 years old or older) and a low age group (105 patients 66 years old or younger) and compared the severity, blood parameters, special therapy, and treatment outcome between groups. We surveyed predictable clinical-course factors on admission in the high age group. Results: The percentage of women and gallstone-associated SAP and severity scores on admission (Ranson, APACHE II, and Japanese scores) were significantly higher in the high age group. For blood biochemical parameters on admission, BUN, creatinine, PaO₂, and CRP differed significantly between the high age group and low age group. Peripheral lymphocyte counts were significantly lower on days 7, 14, and 21 after admission in the high age group. Continuous hemodiafiltration was often required as special therapy in the high age group. The incidence of organ dysfunction and mortality significantly higher in the high age group, and predictable prognosis factors were blood sugar and Ca. Predictable factors of infection were LDH, CRP, and Ca. Predictable factors of organ dysfunction were Ca, white blood cell, IL-6, and base excess. In patients with serum Ca of less than 7.2 mg/dl on admission among high age group, mortality and the incidence of organ dysfunction were significantly higher. Conclusions: These results suggest that organ dysfunction is closely related to mortality in elderly patients, and that serum Ca on admission is useful for predicting the clinical course.

Key words
severe acute pancreatitis, elderly patient, high age, Ca, lymphocyte count

Reprint requests
Takahiro Nakajima Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences
7-5-2 Kusunoki-cho, Kobe, 650-0017 JAPAN

Accepted
April 26, 2006

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