Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study.
ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is a procedure with many complications that sometimes can be devastating. To give better advice to patients referred for PEG regarding risk of complications, important risk factors should be known.
To evaluate whether age, body mass index, albumin levels, C-reactive protein (CRP) levels, indication for PEG, and comorbidity influence the risk of mortality or peristomal infection after PEG insertion.
Prospective cohort study from 2005 to 2009. Follow-up 14 days after PEG.
This study involved 484 patients referred for PEG.
Mortality within 30 days and peristomal infection within 14 days after PEG insertion. All risk estimates were calculated with 95% CIs and adjusted for confounding.
Among 484 patients, 58 (12%) died within 30 days after PEG insertion. Albumin <30 g/L (hazard ratio [HR], 3.46; 95% CI, 1.75-6.88), CRP ≥10 (HR, 3.47; 95% CI, 1.68-7.18), age ≥65 years (HR, 2.26; 95% CI, 1.20-4.25) and possibly body mass index <18.5 (HR, 2.04; 95% CI, 0.97-4.31) were associated with increased mortality. Patients with a combination of low albumin and high CRP levels had a mortality rate of 20.5% compared with 2.6% among patients with normal values, rendering an over 7-fold increased adjusted risk of mortality (HR, 7.45; 95% CI, 2.62-21.19).
Missing data in some study variables. Although the sample size was large, weaker associations could not be established.
The combination of low albumin and high CRP levels indicates a substantially increased short-term mortality risk after PEG, which should be considered in decision making.
- Gastrointestinal endoscopy 01/2012; 75(1):227-8; author reply 228-9. · 6.71 Impact Factor
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ABSTRACT: BACKGROUND & AIMS: Careful selection of patients who undergo endoscopic procedures plays an important role in optimizing healthcare. Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure that has been associated with high short-term mortality. We used a national database to determine the incidence of, and factors associated with in-hospital mortality among patients undergoing PEG. METHODS: We conducted a nested, case-control, retrospective study using the US Nationwide Inpatient Sample (NIS) to analyze data from all hospitalizations in the year 2006 with an ICD-9 procedure code for PEG. Bivariate and multivariate logistic regression analysis was performed using demographic and clinical variables to identify predictors of in-hospital mortality following the procedure. A separate analysis using propensity score matching technique was conducted to compare mortality to a control cohort. Results were validated in an independent analysis of 2007 NIS data. RESULTS: In-hospital mortality was 10.8% (95% CI 10.3%-11.3%) among 181,196 patients who underwent PEG in 2006. Odds of death increased with age (1%/y), congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer and liver disease. Indication for PEG was strongly associated with mortality. Women, and patients with diabetes mellitus or paralysis had lower odds of death. PEG was associated with slightly higher odds of in-hospital mortality compared to controls. Results were qualitatively and quantitatively similar when 2007 NIS data were analyzed. CONCLUSIONS: Mortality is almost 11% among hospital in-patients following PEG. We have identified factors that increase and decrease the risk of death following PEG; these could improve patient selection for those most likely to benefit from this procedure.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2013; · 5.64 Impact Factor
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ABSTRACT: Background Percutaneous endoscopic gastrostomy (PEG) is performed to provide nutrition to patients with swallowing difficulties. A multicenter study was conducted to evaluate the predictors of complications and mortality after PEG placement. Methods This study retrospectively analyzed patients who underwent initial PEG placement between January 2004 and December 2011 at seven tertiary hospitals in the Republic of Korea. Results All 1,625 patients underwent PEG placement by the pull-string method. The median age of the patients was 66 years, and 1,108 of the patients were men. The median follow-up period was 254 days. The common indications were stroke (31.6 %) and malignancy (18.9 %). The complication rate was 13.2 %. The prophylactic use of antibiotics (odds ratio [OR], 0.58; 95 % confidence interval [CI], 0.38–0.88; p = 0.010) reduced the PEG-related infection rate, but the actual usage rate was 81.1 %. The use of anticoagulants (OR, 7.26; 95 % CI, 2.23–23.68; p = 0.001) and the presence of diabetes mellitus (OR, 4.02; 95 % CI, 1.49–10.87; p = 0.006) increased the risk of bleeding, but antiplatelet therapy did not. The procedural, 30-day, and overall mortality rates were 0.2, 2.4 and 14.0 %, respectively. Serum albumin levels lower than 31.5 g/L (OR, 8.55; 95 % CI, 3.11–23.45; p < 0.001) and C-reactive protein levels higher than 21.5 mg/L (OR, 3.01; 95 % CI, 1.27–7.16; p = 0.012) increased the risk of 30-day mortality, and the patients who had both risk factors had a significantly shorter median survival time than those who did not (1,740 vs 3,181 days) (p < 0.001, log-rank). Conclusions The findings showed PEG to be a safe and feasible procedure, but the patient’s nutritional and inflammatory status should be considered in predicting the outcomes of PEG placement.Surgical Endoscopy 05/2013; · 3.43 Impact Factor