Epidemiology of Acute Pancreatitis: The Influence of Age and Gender in a Regional Population

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This study aimed to evaluate the distribution of AP etiologies and their associations with age and sex in a regional cohort from a tertiary center. Materials and Methods This retrospective observational study included 445 adult patients hospitalized with a first episode of AP between January 2022 and October 2023. Data on demographics, etiology, severity (revised Atlanta classification), hospital course, and outcomes were extracted from medical records. Etiologies were classified as biliary, idiopathic, alcohol-related, drug-induced, hypertriglyceridemia (HTG), neoplasm-associated, or other miscellaneous causes. Age was grouped into five categories, and statistical analyses assessed the association between etiologies and demographic variables. Results The median age was 65 years (range: 18–97), and 52.1% were female. Biliary etiology was the most frequent (66.1%), followed by idiopathic (9.4%), alcohol-related (7.0%), drug-induced (6.5%), neoplasm-associated (4.3%), and HTG-induced (3.1%). Females were significantly older than males (median 67 vs. 60 years, p<0.001). Alcohol-related AP (AAP) was more common in males, particularly under age 55. Notably, among biliary AP (BAP) patients, males predominated in those under 55 (p=0.02). Etiological patterns varied significantly by age. In patients aged ≥75 years, BAP was markedly more common (80.4% vs. 61.8%), whereas alcohol-, drug-, and HTG-related etiologies were rare. Severity of AP correlated with age and length of stay but not with etiology. Conclusion Biliary pancreatitis remains the predominant etiology in this region, especially among elderly patients. A novel finding of male predominance in younger BAP cases warrants further investigation. These data underscore the importance of regional age and sex specific approaches to AP prevention and management. acute pancreatitis etiology age gender regional Figures Figure 1 Figure 2 Figure 3 Introduction AP represents an acute inflammatory condition of the pancreas [ 1 ]. It poses a significant global health challenge due to its rising incidence, potential for severe complications, and substantial healthcare burden [ 2 ]. AP is one of the most common gastrointestinal diseases requiring hospitalization in our center. A multitude of factors can trigger AP, including gallstones, alcohol abuse, hypertriglyceridemia, certain medications, post-endoscopic retrograde cholangiopancreatography, hypercalcemia, infections, trauma, autoimmune diseases, anatomical abnormalities, neoplasms, and rare causes. When a definitive etiology cannot be identified, the condition is classified as idiopathic [ 3 ]. The distribution of these etiologies varies considerably based on geographic region and socioeconomic status, adding complexity to the understanding and management of AP [ 3 – 5 ]. Defining the demographics and understanding the varied etiologies across different age and sex groups, as well as the associated outcomes of AP, is paramount for developing tailored diagnosis and management policies to improve patient prognosis. Conflicting findings regarding the prevalence of diverse etiological factors underscore the need for further research in regional populations. Furthermore, the influence of age and sex on the etiology of AP remains an ongoing subject of investigation. While some studies suggest minimal impact, others report significant associations [ 6 – 10 ]. These discrepancies highlight the importance of regionally examining the interplay between demographics and AP etiology. This study aimed to assess the effect of age and gender on the distribution of AP etiologies and related clinical outcomes within Southwestern Turkey, which may provide insights to inform personalized diagnostic and management strategies. Materials and Methods Study Design and Patient Population This is a retrospective, observational, hospitalized patient case series study. The study population included all patients under the care of the gastroenterology department who were diagnosed with AP either upon admission or during their hospitalization and remained in the hospital for at least 48 hours. Patients under the age of 18 and those with recurrent AP were excluded from the study to ensure a focus on the adult population experiencing new-onset AP. For patients with AP who were discharged and subsequently re-hospitalized, only data from their initial hospitalization was considered to maintain the independence of data points and avoid skewing the analysis with repeated episodes from the same individuals. The comprehensive medical records maintained by the gastroenterology department at Antalya Training and Research Hospital, a tertiary care facility equipped to handle complex medical cases, served as the data source. The study period spanned from January 2022 to October 2023.AP was diagnosed based on the Atlanta criteria, which require the presence of at least two of the following three indicators: typical abdominal pain indicative of pancreatic inflammation, elevation of serum amylase or lipase levels to more than three times the normal upper limit, and characteristic imaging findings of AP [ 1 ]. Detailed patient histories and imaging studies were carefully reviewed to determine the etiology of AP in each case. Individualized treatment plans were provided to all patients, which typically consisted of hydration with lactated Ringer's solution to maintain fluid balance, effective pain control, interventions to address nausea, and the introduction of early oral feeding as tolerated, reflecting a comprehensive and patient-centric approach. Age and sex of the patients and etiology of AP recorded. Additionally, we collected the revised Atlanta classification severity index for each patient [ 1 ]. The presence of hypertension and diabetes mellitus, length of stay (LOS) in hospital, intensive care unit (ICU) admission, and in-hospital mortality were also recorded. Post-discharge mortality was calculated only for patients who were re-hospitalized in any ward or emergency service and died within 3 months of the index admission's discharge. We categorized the age of the patients into five age groups based on Apache II score (under 45, 45–54,55–64,65–74, equal or above 75 years old) [ 11 ]. Statistical Analysis Data was collected in excel format. Data analysis was performed using SPSS software (version 27, IBM Corp.). Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges (IQR), based on the distribution. Normality was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were compared using the Mann-Whitney U test due to non-normal distribution. Categorical variables were analyzed using the Chi-square test or Fisher-Freeman-Halton exact test when appropriate. Ordinal and interval associations were assessed using Kendall’s tau-b, Spearman’s rho, and Pearson’s correlation. Binary logistic regression was employed to identify independent predictors while adjusting for potential confounders. A two-tailed p-value of < 0.05 was considered statistically significant. Results Baseline Characteristics A total of 445 patients with AP were included in the analysis. The cohort consisted of 213 males (47.9%) and 232 females (52.1%), with a median age of 65 years (range: 18–97). Biliary acute pancreatitis (BAP) was the most common cause of pancreatitis (66.1%), followed by idiopathic acute pancreatitis (IAP) (9.4%), alcohol-related acute pancreatitis (AAP) (7.0%), drug-induced acute pancreatitis (DAP) (6.5%), neoplasms (4.3%), HTG (3.1%), and other miscellaneous etiologies (3.6%). Miscellaneous cases consisted of post endoscopic retrograde cholangiopancreatography, trauma, infection, pancreatic divisum, post-operative and hypercalcemia induced AP. The median length of hospital stay was 6 days (IQR: 5). ICU admission occurred in 4.9% of cases, in-hospital mortality was 1.8%, and three-month post-discharge mortality was 6.3%. Statistical analysis test indicated that age was not normally distributed in both gender groups (p < 0.001). Age distribution of AP patients by sex is shown in Fig. 1 . The female participants were older than the male participants (median 67 vs 60 years old, p < 0.001). Consequently, the sex ratio varied across different age groups, with males being more prominent in the younger age categories and females being more prominent in the elderly population (p = 0.002). The ratio of males and females according to age category is shown in Fig. 2 . BAP was the most common cause of acute pancreatitis in our series, followed by IAP and AAP. However, the ranking of these etiologies differed between males and females. The distribution of AP etiologies according to sex is presented in Table 1 . Table 1 Etiology of acute pancreatitis according to gender in the study population. Etiology Number of cases % % in Males % in Females Biliary 294 66,1 59,6 72,0 *p = 0,007 Idiopathic 42 9,4 8,0 10,8 NS Alcohol 31 7,0 14,1 0,4 *p < 0,001 Drugs 29 6,5 7,0 6,0 NS Neoplasms 19 4,3 5,2 3,4 NS Triglyceride 14 3,1 4,2 2,2 NS Others 16 3,6 1,9 5,2 NS NS: Not significant. Etiology Across Sex and Age Groups We analyzed the relationship between age, sex, and etiology in 445 patients with AP. For each etiology, we reported the median age. To determine the significance of the difference in distribution ratio of each etiology across age categories, the Kruskal-Wallis test was used to analyze the data. To assess the trends between age and each of the seven etiological categories of AP, separate linear regression analyses were performed using age as the independent variable, and binary-coded etiology variables (1 = presence, 0 = absence) as dependent outcomes. The significance of gender difference is analyzed by chi-square tests. BAP was the most common subtype and predominantly observed in older individuals, with a median age of 65.5 years (IQR: 54–76). Age distribution varied significantly across categories (p < 0.001), and a clear increasing trend with advancing age was noted (p = 0.001). IAP had a median age of 63.5 years (IQR: 43–71), but neither age distribution (p = 0.151) nor age trend (p = 0.161) reached statistical significance. Similarly, sex distribution did not differ significantly (40.5% male; p = 0.334). AAP presented at a significantly younger age, with a median age of 52 years (IQR: 40–60), and showed a strong decreasing trend with age (p < 0.001). This group displayed marked male predominance (96.8% male; p < 0.001). DAP had a median age of 65 years (IQR: 55–70) and showed significant variation in age distribution (p = 0.005), although no consistent age trend was identified (p = 0.980). There was no significant sex predominance in this group (51.7% male; p = 0.704), suggesting a more balanced distribution by sex compared to other etiologies. HTG related AP was observed in the youngest subgroup overall, with a median age of 45 years (IQR: 38–47), showing a significant decreasing age trend (p < 0.001). Although 64.3% of these patients were male, the difference was not statistically significant (p = 0.279), possibly due to limited sample size or confounding metabolic factors. Neoplasm-related AP was found predominantly in older patients, with a median age of 70 years (IQR: 66–79), and both the distribution and increasing age trend were significant (p = 0.039 and p = 0.008, respectively). Despite a slightly higher proportion of males (57.9%), sex differences were not statistically significant (p = 0.483). Other miscellaneous causes, which included fewer common etiologies, showed a broad age distribution (median age 68.5, IQR: 48–81) with no significant difference across age categories (p = 0.701) or trend (p = 0.552). Although only 25% of patients in this category were male, the sex difference did not reach significance (p = 0.076). Altogether the results reflect the different pathophysiology and heterogeneous nature of this group. Subgroup Analysis of Patients Aged ≥ 75 Years Etiologic distribution of pancreatitis differed significantly between patients < 75 years and ≥ 75 years old groups. BAP was markedly more frequent in the elderly group (80.4% vs. 61.8%), while AAP (1.0% vs. 8.7%) was rarely observed, drug induced AP (0.0% vs. 8.5%), and HTG related AP (0.0% vs. 4.1%) were not observed among patients aged ≥ 75 years. IAP and neoplasm-associated etiologies did not differ significantly between patients < 75 years old and ≥ 75 years old groups. These findings suggest a clear shift toward biliary causes in older adults, while lifestyle-related and metabolic causes are more prominent in younger populations. Interestingly, although neoplasm-associated AP had an increasing age trend it has a peak at age of 65–74 years old group. It is not more common in patients ≥ 75 years old. In summary, this analysis highlights significant etiological diversity in AP with distinct age and sex patterns. The results of variations across age categories, age-related trends and gender across different etiological subtypes were presented in Table 2 . Table 2 Characteristics of age, sex, and etiology for acute pancreatitis in the study population. Etiology Median Age (IQR) Age category distribution difference Direction of Age Trend % Male Sex Predominance Biliary 65.5 (54–76) Significant (p M (p = 0.007) Alcohol 52 (40–60) Significant (p = 0.001) Decreases with age (p F (p < 0.001) Drugs 65 (55–70) Significant (p = 0.005) None (p = 0.980) 51.7% No (p = 0.704) HTG 45 (38–47) Significant (p < 0.001) Decreases with age (p < 0.001) 64.3% No (p = 0.279) Idiopathic 63,5 (43–71) NS (p = 0.151 None (p = 0.161) 40.5% No (p = 0.334) Neoplasms 70 (66–79) Significant (p = 0.039) Increases with age (p = 0.008) 57.9% No (p = 0.483) Other causes 68.5 (48–81) NS (p = 0.701) None (p = 0.552) 25% No (p = 0.076) HTG: Hypertriglyceridemia, IQR: Interquartile range, NS: Not significant, F: Female, M: Male. Severity AP was mild in 314 (70,6%) patients, moderate in 111 (24,9%), and severe in 20 (4,5%) patients. There was no significant difference in the severity of AP between males and females. Furthermore, there was no correlation observed between the severity and etiology of AP. Notably the difference in severity of AP between different age groups was significant (p = 0,04). Post hoc analysis showed the severity was significantly greater in the 45–54 age group and in patients aged 75 and older, compared to those under 45 years of age (Fig. 3 ). LOS in hospital increased in proportion to the severity of acute pancreatitis (p < 0.001). However, the etiology of pancreatitis did not appear to impact on the LOS in hospital. In-Hospital Mortality Eight patients (1.8%) died during hospitalization. The median age of the deceased patients was 73 years old (59–95). The patient died in the 4th day of hospitalization was 95 years old, and she died because of cardiovascular reasons. All other 7 patients were in moderately severe or severe AP groups, and they died of MOF after ICU stay with a median of 30-day LOS. A binary logistic regression was performed to identify predictors of in-hospital mortality among patients with APs. The model included age, etiology, and revised Atlanta classification as covariates. Age was independently associated with in-hospital mortality (p = 0.048), indicating that older age increases the risk of death during hospitalization. Atlanta severity classification was a significant predictor (p = 0.001). Compared to mild cases, patients with moderately severe and severe pancreatitis had 71.2 times higher odds of in-hospital death (OR = 71.2; 95% CI: 6.3–804.4; p < 0.001), Etiology was not a significant independent predictor (p = 0.393), and most subgroups had sparse or unstable estimates due to limited events. Post-Discharge Mortality The cumulative incidence of mortality within 90 days after discharge was 6.3% (28 patients) in our cohort. Vast majority of these patients (78.6%) had mild AP, and the median LOS was 6 days. The median age was 74,5 years old (57–97). Of the 28 patients, 12 (42.9%) were in neoplasm-associated AP group (p < 0.001). A separate logistic regression model was used to evaluate predictors of post-discharge mortality, excluding patients who died during hospitalization. Analysis identified age and neoplasm-associated etiology as independent predictors of post-discharge mortality in AP patients (p < 0.001). Severity of AP was not significantly associated with post-discharge mortality (p = 0.414). Subgroup Analysis of Patients with BAP BAP was the most common cause in both genders, and we found that the female participants were older than the male participants (median 67 vs 60 years old, p < 0.001). We were curious whether the difference of age was also solely associated with an increase of AAP in younger males. When we analyzed only BAP cases females were still older than males (median 67 vs 63 years old, p = 0.006). In further analysis of BAP patients, there were 294 (%66.1%) BAP in our 445 AP patient series. Of the 294 BAP patients 167 (56,.8%) were females and 127 (43.2%) were males. 77 (26.2%) of them were under 55 years old and 217 (73.8%) were ≥ 55 years old. Crosstab analysis of BAP patients according to age category showed a statistically significant difference between males and females (p = 0.02). BAP was more common in males under 55 years old and was more common in females who were ≥ 55 years old age. To explore potential confounders underlying the unexpected male predominance in younger BAP patients, we analyzed the possible effects of BMI and smoking status. BMI were similar between males and females; however, smoking was more frequent in male population (p = 0.006). We conducted a multivariable binary logistic regression analysis in BAP patients. The dependent variable was age group (< 55 years vs. ≥55 years), while sex and smoking status were included as independent variables. This approach allowed us to evaluate whether the association between sex and age persisted after adjusting for smoking. The overall model was significant (p < 0.001). Multivariant analysis showed that males were more prevalent in the younger age subgroup (p = 0.044) however, higher prevalence of smoking among younger males was not a confounder of the observed sex and age distribution difference (p = 0.885). Discussion In our cohort, biliary etiology was the most common cause of AP, accounting for a rate approximately six times higher than the next most common cause. This finding is consistent with prior studies from Turkey and Southern Europe, including Köksal et al., who reported a 67.1% biliary etiology rate among 2,144 Turkish patients [ 5 , 12 ]. A similar trend was observed in an international multicenter study, which reported an 82% biliary etiology rate in South American centers [ 13 ]. These observations confirm that BAP is the dominant etiology in many regions, including ours [ 2 – 4 , 12 – 22 ]. Globally, the etiological profile of AP is heterogeneous, shaped by sociocultural, genetic, dietary, and geographic factors [ 3 , 15 , 23 , 24 ]. While biliary etiology predominates in some populations, AAP is the major cause in others, often associated with younger, predominantly male patients [ 3 , 6 , 15 , 18 – 21 , 24 – 26 ]. Our study aligns with the reports that BAP is more frequent in elderly females, consistent with the known higher prevalence of gallstones in older women [ 15 , 19 , 21 , 27 , 28 ]. National data from Turkey indicate a female-to-male gallstone prevalence ratio of 1.37, closely mirrored by our BAP ratio of 1.32 [ 29 ]. However, we also observed a novel pattern of male predominance in BAP among patients under 55, a finding not previously reported. This may be due to regional, lifestyle, or referral factors specific to our tertiary center. A prior study from our institution investigating vitamin D levels in AP showed a similar distribution, suggesting internal consistency [ 30 ]. Moreover female predominance in BAP is not a rule. A recent study from China reported BAP was more common in males [ 18 ]. Similarly male predominance in BAP patients were reported from India and Japan [ 14 , 31 ]. Smoking may be a potential confounding factor for BAP [ 32 ]. In our BAP patients who were under 55 years old, the association between smoking and male sex was statistically significant. However, multivariant analysis showed that smoking is not a confounder of the observed sex distribution. Furthermore, BMI did not differ significantly between younger males and females, Together, these findings suggest that the overrepresentation of males in younger BAP cases in our cohort may not be attributable to smoking and BMI differences. The other unmeasured biological, anatomical, environmental or regional factors may play roles. This interesting and unexpected finding needs further investigation. To further analyze this finding, we have launched a prospective study focused on the age and sex distribution of BAP patients. The IAP rate in our study was 9%, which aligns with data from single-center or prospective studies. 3 In national or data collection studies IAP reaches up to 57.7% [ 6 ]. The meticulous review of patient charts and the availability and common use of EUS and MRCP at out center have resulted in this acceptable IAP percentage. Furthermore, there was no significant variation in idiopathic cases across age or sex groups, reflecting the uncertain pathophysiology and potentially heterogeneous nature of this group. AAP comprised 7% of our total cases, and although relatively low it reflects regional differences in alcohol use, it is a significant issue in younger men in our cohort. In line with the literature, AAP cases in our cohort were almost exclusively younger males [ 26 , 33 ]. The rarer etiologies in our cohort followed expected demographic patterns. Drug induced AP peaked in the 65–74 age group. A significant association was found between age category and drug-induced AP. However, the linear-by-linear association test did not demonstrate a significant trend across age groups, indicating that while the distribution of drug induced AP differs by age, there is no consistent increase or decrease with advancing age. HTG-AP were more common under age 55 years old. This age-dependent pattern is consistent with the epidemiology of metabolic syndrome and genetic lipid disorders, which often manifest earlier in life. Neoplasm-associated AP has a peak in the 65–74 age group. This finding is consistent with the known epidemiology of pancreatic and periampullary malignancies, which are more prevalent in elderly populations and may manifest as first-time pancreatitis [ 3 , 34 , 35 ]. Etiologic differences across age groups were striking, especially in the elderly. In patients aged ≥ 75 years, biliary pancreatitis was significantly more common (80.4% vs. 61.8%), while alcohol-, drug-, and hypertriglyceridemia-related etiologies were markedly less frequent. Idiopathic and neoplasm-associated AP showed no significant age-based variation. These findings underscore the distinct etiologic pattern in elderly patients, emphasizing the importance of age-stratified management strategies [ 9 , 36 , 37 ]. Though our primary objective was to analyze etiologic patterns by age and sex, we also assessed severity, length of stay (LOS), and mortality. We found no significant association between etiology and AP severity, likely due to the predominance of BAP and small numbers in other etiological groups. Some studies suggest alcohol- and HTG-induced AP may have more severe courses, but findings are inconsistent [ 8 , 38 ]. Age-related variation in etiology may also mask any association with severity. Severity increased slightly with age, particularly in patients over 75. As expected, LOS correlated with severity, with severe cases requiring longer hospitalization—a well-documented trend in AP [ 13 , 36 , 38 ]. In-hospital mortality was low (1.8%), with only 8 deaths during admission. Most of these occurred in patients with moderately severe or severe AP, often involving multi-organ failure. Our findings align with literature [ 13 , 39 , 40 ]. In contrast, post-discharge 90-day mortality was 6.3%, mainly among older patients due to neoplasms or cardiovascular events. Notably, many of these patients were initially classified as mild AP, highlighting the importance of monitoring post-discharge outcomes, particularly in elderly patients [ 41 , 42 ]. This study is subject to several limitations. Its retrospective nature introduces potential bias due to missing or inconsistently recorded data. Being a single-center study, the findings may not be generalizable to broader or more diverse populations. The sample sizes in several etiological subgroups (e.g., hypertriglyceridemia, drug-induced AP, neoplasms) were limited, reducing the ability to detect differences between groups. Additionally, compound etiologies were categorized under a single dominant cause, which does not measure multifactorial cases. Post-discharge mortality was tracked only through rehospitalizations or follow-up at our center; thus, deaths occurring outside our system were likely missed, potentially underestimating 90-day mortality. Despite these limitations, this study has notable strengths. It provides detailed analysis of 445 AP patients, a relatively large sample for a single-center study. It contributes valuable regional data on the age- and sex-specific distribution of AP etiologies, including the novel finding of male predominance in younger BAP patients and the distinct etiologic pattern in the elderly. These findings offer important epidemiologic insights and may inform more individualized strategies for AP prevention and management in similar populations. Conclusion Acute pancreatitis etiology and demographic patterns vary widely by geographic region, age, sex, and lifestyle factors. In our region, biliary pancreatitis is overwhelmingly dominant, with a prevalence more than six times that of other etiologies. A novel and unexpected male predominance in BAP under age 55 was identified, which may reflect regional or population-specific factors and warrants further investigation through prospective research. Additionally, we found a distinct shift in etiologic profile among patients aged ≥ 75 years, characterized by a significantly higher rate of biliary pancreatitis and markedly lower rates of alcohol-, drug-, and HTG-related causes. These findings highlight the importance of age-specific considerations in both clinical practice and public health planning. Better understanding of these epidemiologic patterns may support targeted prevention, diagnostic, and treatment strategies for acute pancreatitis tailored to the characteristics of specific patient populations. Abbreviations AP Acute pancreatitis HTG Hypertriglyceridemia LOS Length of stay ICU Intensive care unit IQR Interquartile range OR Odds ratio CI Confidence interval BAP Biliary acute pancreatitis IAP Idiopathic acute pancreatitis DAP Drug-induced acute pancreatitis AAP Alcohol-related acute pancreatitis BMI Body-mass index Declarations Ethics approval and consent to participate The study received ethical approval from the Antalya Training and Research Hospital Ethics Committee (approval number 18/13-2023-322). Given the retrospective nature of the study, informed consent was not required. The need for consent to participate was also waived by the ethics committee of the Antalya Training and Research Hospital. The study was conducted in meticulous accordance with the principles of the Declaration of Helsinki. Consent for publication The manuscript does not contain any individual person’s data as in details, images or videos. Availability of data and material We can provide our Excel and SPSS data files upon request. Competing interests None of the authors declare any conflicts of interest. Funding None. Author contributions Conceptualization: SA, SO, SGK, AHC; Methodology: SA, SO, SGK, OCB, AHC; Formal analysis and investigation: SA, SO, SGK, RK, OCB, GK, GEA, FAH, AHC; Writing - original draft preparation: SA, SO, SGK, OCB, GK, FAH, AHC ; Writing - review and editing: SA, SO, SGK, RK, OCB, GK, GEA, FAH, AHC; Funding acquisition: None; Supervision: SA, SO, OCB, FAH, AHC. All authors consent for this version of the paper to be published. Acknowledgements None. References Banks PA, Bollen TL, Dervenis C, et al.; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. Ouyang G, Pan G, Liu Q, et al. 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Clinical characteristics of three distinct types of pancreatitis with overlapping etiologies: A ten-year retrospective cohort study. Pancreatology. 2023;23(8):949-956. Shabanzadeh DM, Sørensen LT, Jørgensen T. Determinants for gallstone formation - a new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol. 2016;51(10):1239-1248. Sezgin O, Akpınar H, Özer B, Törüner M, Bal K, Bor S. The Abdominal Ultrasonography Results of Cappadocia Cohort Study of Turkey Reveals High Prevalence of Fatty Liver. Turkish Journal of Gastroenterology. 2023;34(6):652-664. Ocal S, Cerci K, Buldukoglu OC, Atar GE, Harmandar FA, Cekin AH. Effect of serum vitamin D levels on the severity of acute pancreatitis: A prospective study. Pancreatology. 2024;24(2):206-210. Masamune A, Kikuta K, Hamada S, et al. Clinical practice of acute pancreatitis in Japan: An analysis of nationwide epidemiological survey in 2016. Pancreatology. 2020;20(4):629-636. Li R, Tang W, Yan S, Yu X, Hu L. A dose-response correlation between smoking and severity of acute pancreatitis: a propensity score-matched study. Front Med (Lausanne). 2024 Jul 29;11:1397111. Drake M, Dodwad SJM, Davis J, Kao LS, Cao Y, Ko TC. Sex-related differences of acute and chronic pancreatitis in adults. J Clin Med. 2021;10(2):1-11. Machicado JD, Yadav D. Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences. Dig Dis Sci. 2017;62(7):1683-1691. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: Cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187. Koziel D, Gluszek-Osuch M, Suliga E, Zak M, Gluszek S. Elderly persons with acute pancreatitis – specifics of the clinical course of the disease. Clin Interv Aging. 2019;14:33-41. Yu B, Li N, Li J, et al. The clinical characteristics of acute pancreatitis in gerontal patients: A retrospective study. Clin Interv Aging. 2020;15:1541-1553. Kim DB, Chung WC, Lee JM, Lee KM, Oh JH, Jeon EJ. Analysis of factors associated with the severity of acute pancreatitis according to etiology. Gastroenterol Res Pract. 2017;2017. Vatansever S, Doğru R, Pakoz ZB, Genç H, Ünsal B. Evaluation of Laboratory Findings and Mortality in Elderly Patients with Acute Biliary Pancreatitis. Sisli Etfal Hastan Tip Bul. 2018 Dec 26;52(4):274-278. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-1703. Davidsen L, Knoph CS, Cook ME, Drewes AM, Olesen SS. Increased Early Post-Discharge Mortality in Patients With Acute Pancreatitis. United European Gastroenterol J. 2025 May;13(4):631-639. Czapári D, Váradi A, Farkas N, et al. Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis. Gastroenterology. 2023;165(3):682-695. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 08 Jul, 2025 Reviews received at journal 05 Jul, 2025 Reviews received at journal 05 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviewers agreed at journal 01 Jul, 2025 Reviewers agreed at journal 28 Jun, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 24 Jun, 2025 Editor invited by journal 03 Jun, 2025 Submission checks completed at journal 31 May, 2025 First submitted to journal 31 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6727765","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477798440,"identity":"dbdd48c1-d9af-4a71-a111-75cb91423fb8","order_by":0,"name":"Serdar Akca","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYDCCAyCCDYh5gPhjA4jH2HiAaC2MMxsYJIBUA/FamHnBWqCCuADf7eMPH1eU2eXz9xx++Nl2h02dbvthoC01NtG4tEieyzE2PHMu2XLG2TZj6dwzaRJmZxKBWo6l5Tbg0GJwhodNsrGN2YDhPA+DdG7bYQmzA0AtjA2H8Whhf/6zsa3eQP48D/NvS5CW8w8JaWEwY2xsO2xgcLaHTZoRpOUGAVskz/AYSzacO25geOaYmWVvW5rkthtAWxLw+IXvDPvDjw1l1QZyZ5If3/jZZsNvdj794YMPNTY4teAACaQpHwWjYBSMglGABgCGT2KWxO2MBQAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Serdar","middleName":"","lastName":"Akca","suffix":""},{"id":477798441,"identity":"692f97ff-6699-466e-9c24-fcd4ee65cd68","order_by":1,"name":"Serkan Ocal","email":"","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Serkan","middleName":"","lastName":"Ocal","suffix":""},{"id":477798442,"identity":"bed553fd-855e-4df8-b394-345542888edd","order_by":2,"name":"Sevgi Gulsen Koc","email":"","orcid":"","institution":"Department of Internal Medicine, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sevgi","middleName":"Gulsen","lastName":"Koc","suffix":""},{"id":477798443,"identity":"97ac0047-934f-4e1b-a90a-b4d06fcade51","order_by":3,"name":"Recep Kaya","email":"","orcid":"","institution":"Department of Internal Medicine, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Recep","middleName":"","lastName":"Kaya","suffix":""},{"id":477798444,"identity":"4c2eec09-0ba2-4b1c-8a80-40f61742652b","order_by":4,"name":"Osman Cagin Buldukoglu","email":"","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Osman","middleName":"Cagin","lastName":"Buldukoglu","suffix":""},{"id":477798445,"identity":"e57db7bb-c124-4d08-ab24-615e880112df","order_by":5,"name":"Gokhan Koker","email":"","orcid":"","institution":"Department of Internal Medicine, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gokhan","middleName":"","lastName":"Koker","suffix":""},{"id":477798446,"identity":"6b94cc09-a077-4348-93ad-603d5122686f","order_by":6,"name":"Galip Egemen Atar","email":"","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Galip","middleName":"Egemen","lastName":"Atar","suffix":""},{"id":477798447,"identity":"5a19c87d-1ee1-4778-83d7-d890ce6f85b5","order_by":7,"name":"Ferda Akbay Harmandar","email":"","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ferda","middleName":"Akbay","lastName":"Harmandar","suffix":""},{"id":477798448,"identity":"8d50b3f7-1041-493f-9a66-7567a65c81ea","order_by":8,"name":"Ayhan Hilmi Cekin","email":"","orcid":"","institution":"Department of Gastroenterology, Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayhan","middleName":"Hilmi","lastName":"Cekin","suffix":""}],"badges":[],"createdAt":"2025-05-22 20:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6727765/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6727765/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-04240-z","type":"published","date":"2025-08-30T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85819157,"identity":"e3e60f5c-a468-469c-bc2b-8ebc00eeaa59","added_by":"auto","created_at":"2025-07-02 06:12:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36774,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution of acute pancreatitis patients by gender.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727765/v1/6c21839da28efa929dd18ea5.jpg"},{"id":85819536,"identity":"3fa0f09e-d1ce-4339-b38e-dcf1e543afdc","added_by":"auto","created_at":"2025-07-02 06:20:17","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30201,"visible":true,"origin":"","legend":"\u003cp\u003eThe ratio of males and females according to age categories.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727765/v1/44d35d8a40cd68506d74280a.jpg"},{"id":85819159,"identity":"fb483cd0-583b-4085-b59c-fe11e2086d41","added_by":"auto","created_at":"2025-07-02 06:12:18","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45874,"visible":true,"origin":"","legend":"\u003cp\u003eAcute pancreatitis severity according to age categories.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727765/v1/5160a7f3f5355f079026380d.jpg"},{"id":90345704,"identity":"30b0fe3c-1e8e-4a74-9802-5c8633c91e74","added_by":"auto","created_at":"2025-09-01 16:10:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":874147,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6727765/v1/a51bec53-6703-4bb2-ada3-15f16a913c14.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology of Acute Pancreatitis: The Influence of Age and Gender in a Regional Population","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAP represents an acute inflammatory condition of the pancreas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It poses a significant global health challenge due to its rising incidence, potential for severe complications, and substantial healthcare burden [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. AP is one of the most common gastrointestinal diseases requiring hospitalization in our center. A multitude of factors can trigger AP, including gallstones, alcohol abuse, hypertriglyceridemia, certain medications, post-endoscopic retrograde cholangiopancreatography, hypercalcemia, infections, trauma, autoimmune diseases, anatomical abnormalities, neoplasms, and rare causes. When a definitive etiology cannot be identified, the condition is classified as idiopathic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The distribution of these etiologies varies considerably based on geographic region and socioeconomic status, adding complexity to the understanding and management of AP [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDefining the demographics and understanding the varied etiologies across different age and sex groups, as well as the associated outcomes of AP, is paramount for developing tailored diagnosis and management policies to improve patient prognosis. Conflicting findings regarding the prevalence of diverse etiological factors underscore the need for further research in regional populations. Furthermore, the influence of age and sex on the etiology of AP remains an ongoing subject of investigation. While some studies suggest minimal impact, others report significant associations [\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These discrepancies highlight the importance of regionally examining the interplay between demographics and AP etiology. This study aimed to assess the effect of age and gender on the distribution of AP etiologies and related clinical outcomes within Southwestern Turkey, which may provide insights to inform personalized diagnostic and management strategies.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Population\u003c/h2\u003e \u003cp\u003eThis is a retrospective, observational, hospitalized patient case series study. The study population included all patients under the care of the gastroenterology department who were diagnosed with AP either upon admission or during their hospitalization and remained in the hospital for at least 48 hours. Patients under the age of 18 and those with recurrent AP were excluded from the study to ensure a focus on the adult population experiencing new-onset AP. For patients with AP who were discharged and subsequently re-hospitalized, only data from their initial hospitalization was considered to maintain the independence of data points and avoid skewing the analysis with repeated episodes from the same individuals.\u003c/p\u003e \u003cp\u003eThe comprehensive medical records maintained by the gastroenterology department at Antalya Training and Research Hospital, a tertiary care facility equipped to handle complex medical cases, served as the data source. The study period spanned from January 2022 to October 2023.AP was diagnosed based on the Atlanta criteria, which require the presence of at least two of the following three indicators: typical abdominal pain indicative of pancreatic inflammation, elevation of serum amylase or lipase levels to more than three times the normal upper limit, and characteristic imaging findings of AP [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Detailed patient histories and imaging studies were carefully reviewed to determine the etiology of AP in each case.\u003c/p\u003e \u003cp\u003e Individualized treatment plans were provided to all patients, which typically consisted of hydration with lactated Ringer's solution to maintain fluid balance, effective pain control, interventions to address nausea, and the introduction of early oral feeding as tolerated, reflecting a comprehensive and patient-centric approach.\u003c/p\u003e \u003cp\u003eAge and sex of the patients and etiology of AP recorded. Additionally, we collected the revised Atlanta classification severity index for each patient [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The presence of hypertension and diabetes mellitus, length of stay (LOS) in hospital, intensive care unit (ICU) admission, and in-hospital mortality were also recorded. Post-discharge mortality was calculated only for patients who were re-hospitalized in any ward or emergency service and died within 3 months of the index admission's discharge.\u003c/p\u003e \u003cp\u003eWe categorized the age of the patients into five age groups based on Apache II score (under 45, 45\u0026ndash;54,55\u0026ndash;64,65\u0026ndash;74, equal or above 75 years old) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData was collected in excel format. Data analysis was performed using SPSS software (version 27, IBM Corp.). Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges (IQR), based on the distribution. Normality was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were compared using the Mann-Whitney U test due to non-normal distribution. Categorical variables were analyzed using the Chi-square test or Fisher-Freeman-Halton exact test when appropriate. Ordinal and interval associations were assessed using Kendall\u0026rsquo;s tau-b, Spearman\u0026rsquo;s rho, and Pearson\u0026rsquo;s correlation. Binary logistic regression was employed to identify independent predictors while adjusting for potential confounders. A two-tailed p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eA total of 445 patients with AP were included in the analysis. The cohort consisted of 213 males (47.9%) and 232 females (52.1%), with a median age of 65 years (range: 18\u0026ndash;97). Biliary acute pancreatitis (BAP) was the most common cause of pancreatitis (66.1%), followed by idiopathic acute pancreatitis (IAP) (9.4%), alcohol-related acute pancreatitis (AAP) (7.0%), drug-induced acute pancreatitis (DAP) (6.5%), neoplasms (4.3%), HTG (3.1%), and other miscellaneous etiologies (3.6%). Miscellaneous cases consisted of post endoscopic retrograde cholangiopancreatography, trauma, infection, pancreatic divisum, post-operative and hypercalcemia induced AP. The median length of hospital stay was 6 days (IQR: 5). ICU admission occurred in 4.9% of cases, in-hospital mortality was 1.8%, and three-month post-discharge mortality was 6.3%.\u003c/p\u003e \u003cp\u003eStatistical analysis test indicated that age was not normally distributed in both gender groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age distribution of AP patients by sex is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe female participants were older than the male participants (median 67 vs 60 years old, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Consequently, the sex ratio varied across different age groups, with males being more prominent in the younger age categories and females being more prominent in the elderly population (p\u0026thinsp;=\u0026thinsp;0.002). The ratio of males and females according to age category is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBAP was the most common cause of acute pancreatitis in our series, followed by IAP and AAP. However, the ranking of these etiologies differed between males and females. The distribution of AP etiologies according to sex is presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEtiology of acute pancreatitis according to gender in the study population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% in Males\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e% in Females\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiliary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e72,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*p\u0026thinsp;=\u0026thinsp;0,007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDrugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTriglyceride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNS: Not significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEtiology Across Sex and Age Groups\u003c/h3\u003e\n\u003cp\u003eWe analyzed the relationship between age, sex, and etiology in 445 patients with AP. For each etiology, we reported the median age. To determine the significance of the difference in distribution ratio of each etiology across age categories, the Kruskal-Wallis test was used to analyze the data. To assess the trends between age and each of the seven etiological categories of AP, separate linear regression analyses were performed using age as the independent variable, and binary-coded etiology variables (1\u0026thinsp;=\u0026thinsp;presence, 0\u0026thinsp;=\u0026thinsp;absence) as dependent outcomes. The significance of gender difference is analyzed by chi-square tests.\u003c/p\u003e \u003cp\u003eBAP was the most common subtype and predominantly observed in older individuals, with a median age of 65.5 years (IQR: 54\u0026ndash;76). Age distribution varied significantly across categories (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a clear increasing trend with advancing age was noted (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIAP had a median age of 63.5 years (IQR: 43\u0026ndash;71), but neither age distribution (p\u0026thinsp;=\u0026thinsp;0.151) nor age trend (p\u0026thinsp;=\u0026thinsp;0.161) reached statistical significance. Similarly, sex distribution did not differ significantly (40.5% male; p\u0026thinsp;=\u0026thinsp;0.334).\u003c/p\u003e \u003cp\u003eAAP presented at a significantly younger age, with a median age of 52 years (IQR: 40\u0026ndash;60), and showed a strong decreasing trend with age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This group displayed marked male predominance (96.8% male; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eDAP had a median age of 65 years (IQR: 55\u0026ndash;70) and showed significant variation in age distribution (p\u0026thinsp;=\u0026thinsp;0.005), although no consistent age trend was identified (p\u0026thinsp;=\u0026thinsp;0.980). There was no significant sex predominance in this group (51.7% male; p\u0026thinsp;=\u0026thinsp;0.704), suggesting a more balanced distribution by sex compared to other etiologies.\u003c/p\u003e \u003cp\u003eHTG related AP was observed in the youngest subgroup overall, with a median age of 45 years (IQR: 38\u0026ndash;47), showing a significant decreasing age trend (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although 64.3% of these patients were male, the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.279), possibly due to limited sample size or confounding metabolic factors.\u003c/p\u003e \u003cp\u003eNeoplasm-related AP was found predominantly in older patients, with a median age of 70 years (IQR: 66\u0026ndash;79), and both the distribution and increasing age trend were significant (p\u0026thinsp;=\u0026thinsp;0.039 and p\u0026thinsp;=\u0026thinsp;0.008, respectively). Despite a slightly higher proportion of males (57.9%), sex differences were not statistically significant (p\u0026thinsp;=\u0026thinsp;0.483).\u003c/p\u003e \u003cp\u003eOther miscellaneous causes, which included fewer common etiologies, showed a broad age distribution (median age 68.5, IQR: 48\u0026ndash;81) with no significant difference across age categories (p\u0026thinsp;=\u0026thinsp;0.701) or trend (p\u0026thinsp;=\u0026thinsp;0.552). Although only 25% of patients in this category were male, the sex difference did not reach significance (p\u0026thinsp;=\u0026thinsp;0.076). Altogether the results reflect the different pathophysiology and heterogeneous nature of this group.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analysis of Patients Aged\u0026thinsp;\u0026ge;\u0026thinsp;75 Years\u003c/h2\u003e \u003cp\u003eEtiologic distribution of pancreatitis differed significantly between patients\u0026thinsp;\u0026lt;\u0026thinsp;75 years and \u0026ge;\u0026thinsp;75 years old groups. BAP was markedly more frequent in the elderly group (80.4% vs. 61.8%), while AAP (1.0% vs. 8.7%) was rarely observed, drug induced AP (0.0% vs. 8.5%), and HTG related AP (0.0% vs. 4.1%) were not observed among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years. IAP and neoplasm-associated etiologies did not differ significantly between patients\u0026thinsp;\u0026lt;\u0026thinsp;75 years old and \u0026ge;\u0026thinsp;75 years old groups. These findings suggest a clear shift toward biliary causes in older adults, while lifestyle-related and metabolic causes are more prominent in younger populations. Interestingly, although neoplasm-associated AP had an increasing age trend it has a peak at age of 65\u0026ndash;74 years old group. It is not more common in patients\u0026thinsp;\u0026ge;\u0026thinsp;75 years old.\u003c/p\u003e \u003cp\u003eIn summary, this analysis highlights significant etiological diversity in AP with distinct age and sex patterns. The results of variations across age categories, age-related trends and gender across different etiological subtypes were presented in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of age, sex, and etiology for acute pancreatitis in the study population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian Age (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge category distribution difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDirection of Age Trend\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% Male\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSex Predominance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.5 (54\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreases with age\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u0026thinsp;\u0026gt;\u0026thinsp;M\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.007)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (40\u0026ndash;60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreases with age\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM\u0026thinsp;\u0026gt;\u0026thinsp;F\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (55\u0026ndash;70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.980)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.704)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (38\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreases with age\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.279)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63,5 (43\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.334)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (66\u0026ndash;79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.039)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreases with age\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.483)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.5 (48\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.701)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.552)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;=\u0026thinsp;0.076)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHTG: Hypertriglyceridemia, IQR: Interquartile range, NS: Not significant, F: Female, M: Male.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSeverity\u003c/h3\u003e\n\u003cp\u003eAP was mild in 314 (70,6%) patients, moderate in 111 (24,9%), and severe in 20 (4,5%) patients. There was no significant difference in the severity of AP between males and females. Furthermore, there was no correlation observed between the severity and etiology of AP. Notably the difference in severity of AP between different age groups was significant (p\u0026thinsp;=\u0026thinsp;0,04). Post hoc analysis showed the severity was significantly greater in the 45\u0026ndash;54 age group and in patients aged 75 and older, compared to those under 45 years of age (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLOS in hospital increased in proportion to the severity of acute pancreatitis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the etiology of pancreatitis did not appear to impact on the LOS in hospital.\u003c/p\u003e\n\u003ch3\u003eIn-Hospital Mortality\u003c/h3\u003e\n\u003cp\u003eEight patients (1.8%) died during hospitalization. The median age of the deceased patients was 73 years old (59\u0026ndash;95). The patient died in the 4th day of hospitalization was 95 years old, and she died because of cardiovascular reasons. All other 7 patients were in moderately severe or severe AP groups, and they died of MOF after ICU stay with a median of 30-day LOS.\u003c/p\u003e \u003cp\u003eA binary logistic regression was performed to identify predictors of in-hospital mortality among patients with APs. The model included age, etiology, and revised Atlanta classification as covariates. Age was independently associated with in-hospital mortality (p\u0026thinsp;=\u0026thinsp;0.048), indicating that older age increases the risk of death during hospitalization. Atlanta severity classification was a significant predictor (p\u0026thinsp;=\u0026thinsp;0.001). Compared to mild cases, patients with moderately severe and severe pancreatitis had 71.2 times higher odds of in-hospital death (OR\u0026thinsp;=\u0026thinsp;71.2; 95% CI: 6.3\u0026ndash;804.4; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Etiology was not a significant independent predictor (p\u0026thinsp;=\u0026thinsp;0.393), and most subgroups had sparse or unstable estimates due to limited events.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePost-Discharge Mortality\u003c/h2\u003e \u003cp\u003eThe cumulative incidence of mortality within 90 days after discharge was 6.3% (28 patients) in our cohort. Vast majority of these patients (78.6%) had mild AP, and the median LOS was 6 days. The median age was 74,5 years old (57\u0026ndash;97). Of the 28 patients, 12 (42.9%) were in neoplasm-associated AP group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A separate logistic regression model was used to evaluate predictors of post-discharge mortality, excluding patients who died during hospitalization. Analysis identified age and neoplasm-associated etiology as independent predictors of post-discharge mortality in AP patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Severity of AP was not significantly associated with post-discharge mortality (p\u0026thinsp;=\u0026thinsp;0.414).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analysis of Patients with BAP\u003c/h2\u003e \u003cp\u003eBAP was the most common cause in both genders, and we found that the female participants were older than the male participants (median 67 vs 60 years old, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). We were curious whether the difference of age was also solely associated with an increase of AAP in younger males. When we analyzed only BAP cases females were still older than males (median 67 vs 63 years old, p\u0026thinsp;=\u0026thinsp;0.006). In further analysis of BAP patients, there were 294 (%66.1%) BAP in our 445 AP patient series. Of the 294 BAP patients 167 (56,.8%) were females and 127 (43.2%) were males. 77 (26.2%) of them were under 55 years old and 217 (73.8%) were \u0026ge;\u0026thinsp;55 years old. Crosstab analysis of BAP patients according to age category showed a statistically significant difference between males and females (p\u0026thinsp;=\u0026thinsp;0.02). BAP was more common in males under 55 years old and was more common in females who were \u0026ge;\u0026thinsp;55 years old age.\u003c/p\u003e \u003cp\u003eTo explore potential confounders underlying the unexpected male predominance in younger BAP patients, we analyzed the possible effects of BMI and smoking status. BMI were similar between males and females; however, smoking was more frequent in male population (p\u0026thinsp;=\u0026thinsp;0.006). We conducted a multivariable binary logistic regression analysis in BAP patients. The dependent variable was age group (\u0026lt;\u0026thinsp;55 years vs. \u0026ge;55 years), while sex and smoking status were included as independent variables. This approach allowed us to evaluate whether the association between sex and age persisted after adjusting for smoking. The overall model was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Multivariant analysis showed that males were more prevalent in the younger age subgroup (p\u0026thinsp;=\u0026thinsp;0.044) however, higher prevalence of smoking among younger males was not a confounder of the observed sex and age distribution difference (p\u0026thinsp;=\u0026thinsp;0.885).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our cohort, biliary etiology was the most common cause of AP, accounting for a rate approximately six times higher than the next most common cause. This finding is consistent with prior studies from Turkey and Southern Europe, including K\u0026ouml;ksal et al., who reported a 67.1% biliary etiology rate among 2,144 Turkish patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A similar trend was observed in an international multicenter study, which reported an 82% biliary etiology rate in South American centers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These observations confirm that BAP is the dominant etiology in many regions, including ours [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, the etiological profile of AP is heterogeneous, shaped by sociocultural, genetic, dietary, and geographic factors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. While biliary etiology predominates in some populations, AAP is the major cause in others, often associated with younger, predominantly male patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study aligns with the reports that BAP is more frequent in elderly females, consistent with the known higher prevalence of gallstones in older women [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. National data from Turkey indicate a female-to-male gallstone prevalence ratio of 1.37, closely mirrored by our BAP ratio of 1.32 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, we also observed a novel pattern of male predominance in BAP among patients under 55, a finding not previously reported. This may be due to regional, lifestyle, or referral factors specific to our tertiary center. A prior study from our institution investigating vitamin D levels in AP showed a similar distribution, suggesting internal consistency [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Moreover female predominance in BAP is not a rule. A recent study from China reported BAP was more common in males [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly male predominance in BAP patients were reported from India and Japan [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSmoking may be a potential confounding factor for BAP [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our BAP patients who were under 55 years old, the association between smoking and male sex was statistically significant. However, multivariant analysis showed that smoking is not a confounder of the observed sex distribution. Furthermore, BMI did not differ significantly between younger males and females, Together, these findings suggest that the overrepresentation of males in younger BAP cases in our cohort may not be attributable to smoking and BMI differences. The other unmeasured biological, anatomical, environmental or regional factors may play roles. This interesting and unexpected finding needs further investigation. To further analyze this finding, we have launched a prospective study focused on the age and sex distribution of BAP patients.\u003c/p\u003e \u003cp\u003eThe IAP rate in our study was 9%, which aligns with data from single-center or prospective studies.\u003csup\u003e3\u003c/sup\u003e In national or data collection studies IAP reaches up to 57.7% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The meticulous review of patient charts and the availability and common use of EUS and MRCP at out center have resulted in this acceptable IAP percentage. Furthermore, there was no significant variation in idiopathic cases across age or sex groups, reflecting the uncertain pathophysiology and potentially heterogeneous nature of this group.\u003c/p\u003e \u003cp\u003eAAP comprised 7% of our total cases, and although relatively low it reflects regional differences in alcohol use, it is a significant issue in younger men in our cohort. In line with the literature, AAP cases in our cohort were almost exclusively younger males [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The rarer etiologies in our cohort followed expected demographic patterns. Drug induced AP peaked in the 65\u0026ndash;74 age group. A significant association was found between age category and drug-induced AP. However, the linear-by-linear association test did not demonstrate a significant trend across age groups, indicating that while the distribution of drug induced AP differs by age, there is no consistent increase or decrease with advancing age. HTG-AP were more common under age 55 years old. This age-dependent pattern is consistent with the epidemiology of metabolic syndrome and genetic lipid disorders, which often manifest earlier in life. Neoplasm-associated AP has a peak in the 65\u0026ndash;74 age group. This finding is consistent with the known epidemiology of pancreatic and periampullary malignancies, which are more prevalent in elderly populations and may manifest as first-time pancreatitis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEtiologic differences across age groups were striking, especially in the elderly. In patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years, biliary pancreatitis was significantly more common (80.4% vs. 61.8%), while alcohol-, drug-, and hypertriglyceridemia-related etiologies were markedly less frequent. Idiopathic and neoplasm-associated AP showed no significant age-based variation. These findings underscore the distinct etiologic pattern in elderly patients, emphasizing the importance of age-stratified management strategies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThough our primary objective was to analyze etiologic patterns by age and sex, we also assessed severity, length of stay (LOS), and mortality. We found no significant association between etiology and AP severity, likely due to the predominance of BAP and small numbers in other etiological groups. Some studies suggest alcohol- and HTG-induced AP may have more severe courses, but findings are inconsistent [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Age-related variation in etiology may also mask any association with severity.\u003c/p\u003e \u003cp\u003eSeverity increased slightly with age, particularly in patients over 75. As expected, LOS correlated with severity, with severe cases requiring longer hospitalization\u0026mdash;a well-documented trend in AP [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn-hospital mortality was low (1.8%), with only 8 deaths during admission. Most of these occurred in patients with moderately severe or severe AP, often involving multi-organ failure. Our findings align with literature [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In contrast, post-discharge 90-day mortality was 6.3%, mainly among older patients due to neoplasms or cardiovascular events. Notably, many of these patients were initially classified as mild AP, highlighting the importance of monitoring post-discharge outcomes, particularly in elderly patients [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study is subject to several limitations. Its retrospective nature introduces potential bias due to missing or inconsistently recorded data. Being a single-center study, the findings may not be generalizable to broader or more diverse populations. The sample sizes in several etiological subgroups (e.g., hypertriglyceridemia, drug-induced AP, neoplasms) were limited, reducing the ability to detect differences between groups. Additionally, compound etiologies were categorized under a single dominant cause, which does not measure multifactorial cases. Post-discharge mortality was tracked only through rehospitalizations or follow-up at our center; thus, deaths occurring outside our system were likely missed, potentially underestimating 90-day mortality.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study has notable strengths. It provides detailed analysis of 445 AP patients, a relatively large sample for a single-center study. It contributes valuable regional data on the age- and sex-specific distribution of AP etiologies, including the novel finding of male predominance in younger BAP patients and the distinct etiologic pattern in the elderly. These findings offer important epidemiologic insights and may inform more individualized strategies for AP prevention and management in similar populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAcute pancreatitis etiology and demographic patterns vary widely by geographic region, age, sex, and lifestyle factors. In our region, biliary pancreatitis is overwhelmingly dominant, with a prevalence more than six times that of other etiologies. A novel and unexpected male predominance in BAP under age 55 was identified, which may reflect regional or population-specific factors and warrants further investigation through prospective research.\u003c/p\u003e \u003cp\u003eAdditionally, we found a distinct shift in etiologic profile among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years, characterized by a significantly higher rate of biliary pancreatitis and markedly lower rates of alcohol-, drug-, and HTG-related causes. These findings highlight the importance of age-specific considerations in both clinical practice and public health planning.\u003c/p\u003e \u003cp\u003eBetter understanding of these epidemiologic patterns may support targeted prevention, diagnostic, and treatment strategies for acute pancreatitis tailored to the characteristics of specific patient populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHTG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertriglyceridemia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBiliary acute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIdiopathic acute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDrug-induced acute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlcohol-related acute pancreatitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody-mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Antalya Training and Research Hospital Ethics Committee (approval number 18/13-2023-322). Given the retrospective nature of the study, informed consent was not required. The need for consent to participate was also waived by the ethics committee of the Antalya Training and Research Hospital. The study was conducted in meticulous accordance with the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript does not contain any individual person’s data as in details, images or videos.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe can provide our Excel and SPSS data files upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors declare any conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: SA, SO, SGK,\u0026nbsp;AHC; Methodology:\u0026nbsp;SA, SO, SGK,\u0026nbsp;OCB, AHC;\u0026nbsp;Formal analysis and investigation: SA, SO, SGK, RK,\u0026nbsp;OCB, GK, GEA, FAH, AHC;\u0026nbsp;Writing - original draft preparation: SA, SO, SGK,\u0026nbsp;OCB, GK, FAH, AHC\u0026nbsp;; Writing - review and editing:\u0026nbsp;SA, SO, SGK, RK,\u0026nbsp;OCB, GK, GEA, FAH, AHC;\u0026nbsp;Funding acquisition:\u0026nbsp;None;\u0026nbsp;Supervision:\u0026nbsp;SA, SO,\u0026nbsp;OCB, FAH, AHC.\u0026nbsp;All authors consent for this version of the paper to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBanks PA, Bollen TL, Dervenis C, et al.; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11.\u003c/li\u003e\n \u003cli\u003eOuyang G, Pan G, Liu Q, et al. The global, regional, and national burden of pancreatitis in 195 countries and territories, 1990\u0026ndash;2017: a systematic analysis for the Global Burden of Disease Study 2017. BMC Med. 2020;18(1).\u003c/li\u003e\n \u003cli\u003eZilio MB, Eyff TF, Azeredo-Da-Silva ALF, Bersch VP, Osvaldt AB. A systematic review and meta-analysis of the aetiology of acute pancreatitis. HPB. 2019;21(3):259-267.\u003c/li\u003e\n \u003cli\u003eG\u0026oacute;mez P\u0026eacute;rez A, Aparicio Serrano A, Serrano Ruiz FJ. Etiological diagnosis of recurrent acute pancreatitis. Revista espanola de enfermedades digestivas. 2024;116(8):399-403.\u003c/li\u003e\n \u003cli\u003eK\u0026ouml;ksal AŞ, Tozlu M, Sezgin O, et al. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. 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A Descriptive Study of the Demographic and Clinicopathological Characteristics of Individuals With Gallstone-Induced Pancreatitis in a Tertiary-Level Hospital in Ranchi, Jharkhand. Cureus. Published online April 9, 2024.\u003c/li\u003e\n \u003cli\u003eMittal N, Oza VM, Muniraj T, Kothari TH. Diagnosis and Management of Acute Pancreatitis. Diagnostics. 2025;15(3):258.\u003c/li\u003e\n \u003cli\u003eVos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-1259.\u003c/li\u003e\n \u003cli\u003eHan K, Chen S, Song Y, et al. Burden of pancreatitis and associated risk factors in China, 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Chin Med J (Engl). 2022;135(11):1340-1347.\u003c/li\u003e\n \u003cli\u003eHuang Y, Qiu M, Pan S, et al. Temporal trends in gender, etiology, severity and outcomes of acute pancreatitis in a third-tier Chinese city from 2013 to 2021. Ann Med. 2025;57(1).\u003c/li\u003e\n \u003cli\u003eEdu AV, Pahomeanu MR, Olăreanu A, et al. Epidemiology of Biliary Acute Pancreatitis\u0026mdash;A Seven-Year Experience of a Large Tertiary Center. Life. 2025;15(2):139.\u003c/li\u003e\n \u003cli\u003eGhiță AI, Pahomeanu MR, Negreanu L. Epidemiological trends in acute pancreatitis: A retrospective cohort in a tertiary center over a seven year period. World J Methodol. 2023;13(3):118-126.\u003c/li\u003e\n \u003cli\u003eKosti A, Borakati A, Varma A, et al. PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK. BJS Open. 2023 May 5;7(3):zrad008.\u003c/li\u003e\n \u003cli\u003eZheng Y, Zhou Z, Li H, et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015;44(3):409-414.\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;ğ\u0026uuml;tmen Ko\u0026ccedil; D, Bengi G, G\u0026uuml;l \u0026Ouml;, et al. Turkish Society of Gastroenterology: Pancreas Working Group, Acute Pancreatitis Committee Consensus Report. Turk J Gastroenterol. 2024 Nov 11;35(Suppl 1):S1-S44.\u003c/li\u003e\n \u003cli\u003eLi T, Qin C, Zhao B, et al. Global and regional burden of pancreatitis: epidemiological trends, risk factors, and projections to 2050 from the global burden of disease study 2021. BMC Gastroenterol. 2024;24(1).\u003c/li\u003e\n \u003cli\u003eSohail Z, Shaikh H, Iqbal N, Parkash O. Acute pancreatitis: A narrative review. J Pak Med Assoc. 2024;74(5):953-958.\u003c/li\u003e\n \u003cli\u003eHari Y. A Study of the Differences in Age, Gender and Outcome in Patients with Alcohol Induced Acute Pancreatitis vs Non Alcohol Induced Acute Pancreatitis. International Journal of Science and Research (IJSR). 2023;12(12):1565-1571.\u003c/li\u003e\n \u003cli\u003eZhang Q, Fu Z, Li S, et al. Clinical characteristics of three distinct types of pancreatitis with overlapping etiologies: A ten-year retrospective cohort study. Pancreatology. 2023;23(8):949-956.\u003c/li\u003e\n \u003cli\u003eShabanzadeh DM, S\u0026oslash;rensen LT, J\u0026oslash;rgensen T. Determinants for gallstone formation - a new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol. 2016;51(10):1239-1248.\u003c/li\u003e\n \u003cli\u003eSezgin O, Akpınar H, \u0026Ouml;zer B, T\u0026ouml;r\u0026uuml;ner M, Bal K, Bor S. The Abdominal Ultrasonography Results of Cappadocia Cohort Study of Turkey Reveals High Prevalence of Fatty Liver. Turkish Journal of Gastroenterology. 2023;34(6):652-664.\u003c/li\u003e\n \u003cli\u003eOcal S, Cerci K, Buldukoglu OC, Atar GE, Harmandar FA, Cekin AH. Effect of serum vitamin D levels on the severity of acute pancreatitis: A prospective study. Pancreatology. 2024;24(2):206-210.\u003c/li\u003e\n \u003cli\u003eMasamune A, Kikuta K, Hamada S, et al. Clinical practice of acute pancreatitis in Japan: An analysis of nationwide epidemiological survey in 2016. Pancreatology. 2020;20(4):629-636.\u003c/li\u003e\n \u003cli\u003eLi R, Tang W, Yan S, Yu X, Hu L. A dose-response correlation between smoking and severity of acute pancreatitis: a propensity score-matched study. Front Med (Lausanne). 2024 Jul 29;11:1397111.\u003c/li\u003e\n \u003cli\u003eDrake M, Dodwad SJM, Davis J, Kao LS, Cao Y, Ko TC. Sex-related differences of acute and chronic pancreatitis in adults. J Clin Med. 2021;10(2):1-11.\u003c/li\u003e\n \u003cli\u003eMachicado JD, Yadav D. Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences. Dig Dis Sci. 2017;62(7):1683-1691.\u003c/li\u003e\n \u003cli\u003eStinton LM, Shaffer EA. Epidemiology of gallbladder disease: Cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187.\u003c/li\u003e\n \u003cli\u003eKoziel D, Gluszek-Osuch M, Suliga E, Zak M, Gluszek S. Elderly persons with acute pancreatitis \u0026ndash; specifics of the clinical course of the disease. Clin Interv Aging. 2019;14:33-41.\u003c/li\u003e\n \u003cli\u003eYu B, Li N, Li J, et al. The clinical characteristics of acute pancreatitis in gerontal patients: A retrospective study. Clin Interv Aging. 2020;15:1541-1553.\u003c/li\u003e\n \u003cli\u003eKim DB, Chung WC, Lee JM, Lee KM, Oh JH, Jeon EJ. Analysis of factors associated with the severity of acute pancreatitis according to etiology. Gastroenterol Res Pract. 2017;2017.\u003c/li\u003e\n \u003cli\u003eVatansever S, Doğru R, Pakoz ZB, Gen\u0026ccedil; H, \u0026Uuml;nsal B. Evaluation of Laboratory Findings and Mortality in Elderly Patients with Acute Biliary Pancreatitis. Sisli Etfal Hastan Tip Bul. 2018 Dec 26;52(4):274-278.\u003c/li\u003e\n \u003cli\u003eWu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-1703.\u003c/li\u003e\n \u003cli\u003eDavidsen L, Knoph CS, Cook ME, Drewes AM, Olesen SS. Increased Early Post-Discharge Mortality in Patients With Acute Pancreatitis. United European Gastroenterol J. 2025 May;13(4):631-639.\u003c/li\u003e\n \u003cli\u003eCzap\u0026aacute;ri D, V\u0026aacute;radi A, Farkas N, et al. Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis. Gastroenterology. 2023;165(3):682-695.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acute pancreatitis, etiology, age, gender, regional","lastPublishedDoi":"10.21203/rs.3.rs-6727765/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6727765/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nAcute pancreatitis (AP) is a common and potentially severe inflammatory condition of the pancreas with a heterogeneous etiology influenced by geographic, demographic, and lifestyle factors. This study aimed to evaluate the distribution of AP etiologies and their associations with age and sex in a regional cohort from a tertiary center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e\u003cbr\u003e\nThis retrospective observational study included 445 adult patients hospitalized with a first episode of AP between January 2022 and October 2023. Data on demographics, etiology, severity (revised Atlanta classification), hospital course, and outcomes were extracted from medical records. Etiologies were classified as biliary, idiopathic, alcohol-related, drug-induced, hypertriglyceridemia (HTG), neoplasm-associated, or other miscellaneous causes. Age was grouped into five categories, and statistical analyses assessed the association between etiologies and demographic variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nThe median age was 65 years (range: 18–97), and 52.1% were female. Biliary etiology was the most frequent (66.1%), followed by idiopathic (9.4%), alcohol-related (7.0%), drug-induced (6.5%), neoplasm-associated (4.3%), and HTG-induced (3.1%). Females were significantly older than males (median 67 vs. 60 years, p\u0026lt;0.001). Alcohol-related AP (AAP) was more common in males, particularly under age 55. Notably, among biliary AP (BAP) patients, males predominated in those under 55 (p=0.02). Etiological patterns varied significantly by age. In patients aged ≥75 years, BAP was markedly more common (80.4% vs. 61.8%), whereas alcohol-, drug-, and HTG-related etiologies were rare. Severity of AP correlated with age and length of stay but not with etiology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nBiliary pancreatitis remains the predominant etiology in this region, especially among elderly patients. A novel finding of male predominance in younger BAP cases warrants further investigation. These data underscore the importance of regional age and sex specific approaches to AP prevention and management.\u003c/p\u003e","manuscriptTitle":"Epidemiology of Acute Pancreatitis: The Influence of Age and Gender in a Regional Population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 06:12:13","doi":"10.21203/rs.3.rs-6727765/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-08T04:40:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-05T16:06:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-05T13:05:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194611980134294605296501325621166542372","date":"2025-07-02T10:42:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190568383997788761586535452765609993840","date":"2025-07-01T13:13:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8386761728527256000424224010850861520","date":"2025-06-28T17:33:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281128846282132590737772307672332143103","date":"2025-06-28T00:35:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T22:43:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-24T12:05:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-03T05:43:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-31T13:24:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-05-31T13:22:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14c45f5a-fc4f-49a8-ad86-b34f05fc6e16","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:09:44+00:00","versionOfRecord":{"articleIdentity":"rs-6727765","link":"https://doi.org/10.1186/s12876-025-04240-z","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-08-30 15:56:54","publishedOnDateReadable":"August 30th, 2025"},"versionCreatedAt":"2025-07-02 06:12:13","video":"","vorDoi":"10.1186/s12876-025-04240-z","vorDoiUrl":"https://doi.org/10.1186/s12876-025-04240-z","workflowStages":[]},"version":"v1","identity":"rs-6727765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6727765","identity":"rs-6727765","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}