Background:Acute pancreatitis (AP) is a common condition encountered during clinical practice; 20% of patients have pancreatic necrosis, and the mortality is high. This study aimed to explore the clinical characteristics and prognosis of older adult patients with necrotizing pancreatitis (NP).Methods:We searched for 1159 patients with AP admitted to the General Surgery Department of Xuanwu Hospital from January 2014 to December 2021. After screening medical history and imaging examinations, a total of 109 patients were divided into a death group (n = 31) and a survival group (n = 78), and their clinical characteristics and prognosis were further analyzed.Results:In the death group, the scope of pancreatic necrosis was more extensive, the evidence of infection was apparent, the nutritional status and the clinical outcome were worse. In addition, patients in the death group have a higher proportion of organ failure and infection, and longer intensive care unit (ICU) hospitalization time.Conclusion:Preoperative persistent organ failure (POF) and prolonged hospitalization in ICU are independent risk factors leading to increased mortality in elderly patients with NP. Early identification of risk factors, timely drug treatment and surgical intervention are essential to improve the prognosis of older adult patients and reduce mortality.