A retrospective analysis of clinical characteristics and prognosis of infected pancreatic necrosis in elderly patients / 中华肝胆外科杂志

ABSTRACT

Objective:To evaluate the clinical characteristics and prognosis of elderly patients with infected pancreatic necrosis (IPN).Methods:Clinical data of IPN patients admitted in the Acute Pancreatitis Clinical Center of Xuanwu Hospital of Capital Medical University from January 1, 2014 to October 30, 2018 were retrospectively collected analyzed. These patients were separated into elderly group (older than 65 years old) and young group (less than 65 years old). These clinical data were analyzed between the two groups, including age, sex, comorbidities, laboratory and imaging examinations, treatment methods and outcomes, length of hospital stay, length of ICU stay and mortality.Results:A total of 163 patients were included. In the elderly group, there were 42 patients aged 67.00(65.50, 77.00), with 22 males and 20 females. In the young group, there were 121 patients aged 44.00(33.25, 52.00), with 90 males and 31 females. The ratio of male to female in the elderly group was 47.62% (20/42), which was significantly higher than that in the young group [25.62% (31/121), P<0.05]. The etiological cause of acute pancreatitis for 83.33% (35/42) elderly IPN patients were biliary diseases, while only 43.80% (53/121) of young IPN patients were caused by biliary diseases ( P<0.05). Elderly IPN patients had higher rates of coronary artery disease and hypertension co-morbidities compared to those of the young patients (all P<0.05). The level of aspartate aminotransferase and blood urea nitrogen in the elderly group were significantly higher than those of the young group [37.00 (27.50, 58.00) IU/L vs. 28.00 (18.50, 44.00) IU/L; 6.36 (4.23, 10.89) mmol/L vs. 4.68 (3.23, 7.15) mmol/L, P<0.05]. However, the level of triglyceride was significantly lower [1.05 (0.78, 1.35) mmol/L vs. 2.26 (1.32, 18.55) mmol/L, P<0.05]. There were no significant differences in local complications, but the rate of persistent organ failure was significantly higher in the elderly group than that of the young group [30.95% (13/42) vs. 12.40% (15/121), P<0.05]. The duration of total parenteral nutrition for elderly IPN patients were significantly longer than those of young patients [22.00 (13.25, 43.50) d vs. 17.00 (9.00, 26.00) d, P<0.05]. However, the rate of patients that received surgery intervention was more than twice which was significantly lower in the elderly group than that of the young group [26.19% (11/42) vs. 43.80% (52/121), P<0.05]. The mortality rate for elderly IPN patients was significantly higher than those of young patients [21.43% (9/42) vs. 7.44% (9/121), P<0.05]. Conclusions:Elderly IPN patients were associated with a higher proportion of female than the young IPN patients. Elderly IPN patients usually have a higher proportion of cardiovascular comorbidities, and are associated with higher persistent organ failure rates and mortality rates.