Aging and Comorbidities in Acute Pancreatitis I: A Meta-Analysis and Systematic Review Based on 194,702 Patients

Abstract

Background: Acute pancreatitis (AP) is one of the most common cause of hospitalization among gastrointestinal diseases worldwide. Although most of the cases are mild, approximately 10–20% of patients develop a severe course of disease with higher mortality rate. Scoring systems consider age as a risk factor of mortality and severity (BISAP; >60 years, JPN>70 years, RANSON; >55 years, APACHE II >45 years). If there is a correlation between aging and the clinical features of AP, how does age influence mortality and severity? Aim: This study aimed to systematically review the effects of aging on AP. Methods: A comprehensive systematic literature search was conducted in the Embase, Cochrane, and Pubmed databases. A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis statement (PRISMA). A total of 1,100 articles were found. After removing duplicates and articles containing insufficient or irrelevant data, 33 publications involving 194,702 AP patients were analyzed. Seven age categories were determined and several mathematical models, including conventional mathematical methods (linear regression), meta-analyses (random effect model and heterogeneity tests), meta-regression, funnel plot and Egger's test for publication bias were performed. Quality assessment was conducted using the modified Newcastle–Ottawa scale. The meta-analysis was registered in the PROSPERO database (CRD42017079253). Results: Aging greatly influences the outcome of AP. There was a low severe AP incidence in patients under 30 (1.6%); however, the incidence of severe AP showed a continuous, linear increase between 20 and 70 (0.193%/year) of up to 9.6%. The mortality rate was 0.9% in patients under 20 and demonstrated a continuous linear elevation until 59, however from this age the mortality rate started elevating with 9 times higher rate until the age of 70. The mortality rate between 20 and 59 grew 0.086%/year and 0.765%/year between 59 and 70. Overall, patients above 70 had a 19 times higher mortality rate than patients under 20. The mortality rate rising with age was confirmed by meta-regression (coefficient: 0.037 CI: 0.006–0.068, p = 0.022; adjusted r 2 : 13.8%), and severity also (coefficient: 0.035 CI: 0.019–0.052, p < 0.001; adjusted r 2 : 31.6%). Conclusion: Our analysis shows a likelihood of severe pancreatitis, as well as, pancreatitis-associated mortality is more common with advanced age. Importantly, the rapid elevation of mortality above the age of 59 suggests the involvement of additional deteriorating factors such as co-morbidity in elderly.

Open Abdomen Treatment in Acute Pancreatitis

“…The incidence of AP is currently on the rise in western countries while particularly elderly patients are affected with most individuals being in their 70s ( 15 ). Not surprisingly, a higher disease-related mortality could be evidenced in these compared to younger patients ( 16 ). In contrast, it is the middle-aged adults who were reported to have the highest risk for aggravated disease, which is in concordance with the mean age of 52 years in our analysis ( 17 ).…”

Refeeding syndrome in a woman with pancreatitis: a case report

“…Indeed, comorbidities and conditions in the anamnesis may influence the patient’s vulnerability to RFS, the diagnosis of which is based on hydro-electrolyte disorders including hypophosphatemia, hypocalcemia, hypokalemia, and hyperglycemia. 26 Hyperglycemia is often found in patients with pancreatitis and results from insulin resistance, increased glucose production in the liver, and impaired insulin secretion caused by beta-cell damage. 4 Hypocalcemia may be related to saponification of calcium, hypomagnesemia, decreased parathyroid hormone release, and an increased calcitonin concentration.…”

Escala BISAP en pancreatitis aguda. Azogues 2016-2017. Estudio descriptivo.

“…En 2017, se analizó retrospectivamente la documentación de 963 pacientes en Polonia, demostrando que los pacientes con edad ≥ 65 años representaron el 32.5% de todos los pacientes con pancreatitis aguda [15]. Márta et al [16] indican que los sistemas de puntuación consideran la edad avanzada como un factor de riesgo de mortalidad (p=0.022) y severidad (p <0.001); la elevación de 9 veces la mortalidad por encima de los 59 años sugiere la participación de factores de deterioro adicionales, como la comorbilidad en personas de edad avanzada.…”