ACUTE-PANCREATITIS OF UNKNOWN ETIOLOGY IN THE ELDERLY

Objective The incidence of acute pancreatitis in the elderly patient i s increasing, and a significant number of such patients have no clearl y defined etiology of their pancreatitis. To delineate the role of ear ly organ failure versus progressive pancreatic disease in the morbidit y and mortality, the authors' experience with patients older than 60 y ears with acute pancreatitis was reviewed. Summary Background Data As many as 30%-40% of elderly patients with acute pancreatitis have an un clear etiology and such patients have high rates of early organ failur e and death. While some authorities have shown that pre-existing disea se in these elderly patients did not contribute to subsequent morbidit y, others have demonstrated that poor outcome was related to co-existi ng medical illness. Methods Their review of acute pancreatitis in the elderly was grouped into known and unknown etiology patients. Various parameters such as morbidity, mortality and length of stay were then c ompared between the two groups. Severity of organ failure and acute pa ncreatitis on admission were both graded and attempts made to correlat e this severity with subsequent outcome. Results Unknown etiology pati ents had a greater number of Ranson's criteria (3.5 +/- .44 vs. 2.4 +/ - .18) (p < 0.02), higher morbidity (48% vs. 22%) (p < 0.05), higher m ortality (24% vs. 8.3%), and more SICU days (4.4 +/- 1.3 vs. 1.6 +/- . 44) (p < 0.05) when compared with the known etiology group. Duration o f symptoms, admission hypotension, and Ranson's criteria were unsucces sful in predicting mortality. Functional status of the various organ s ystems on admission did predict subsequent mortality. Conclusions Elde rly patients with acute pancreatitis of unknown etiology present with a more severe disease, have higher morbidity and longer SICU stays, an d appear to have greater compromise of organ function. Organ function compromise correlates with mortality and appears more significant than severity of pancreatic disease. Aggressive support of such organ syst ems may be beneficial in the management of these patients.