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Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein.
Clin Nutr ESPEN. 2016 08; 14:19-23.CN

Abstract

INTRODUCTION AND AIMS

Percutaneous endoscopic gastrostomy (PEG) is considered one of the preferred routes for long-term enteral feeding. However, early mortality after PEG placement is high. We aimed at analyzing overall and early mortality in patients who underwent PEG insertion and at identifying risk factors of increased mortality after the procedure.

METHODS

Retrospective study which included patients who had a PEG insertion at our department between May 2007 and January 2013. Variables analyzed: demographic, Charlson's co-morbidity index, past aspiration pneumonia, indication for PEG, hemogram, ionogram, urea, creatinine, albumin and C-reactive protein (CRP).

OUTCOME

death. Kaplan-Meier survival analysis was used to calculate mortality after PEG placement. Predictive factors of overall mortality were identified by univariate and multivariate analysis and of 30-day, 90-day and 180-day mortality by logistic regression. The AUROC analysis for CRP levels was performed.

RESULTS

Inclusion of 135 patients: 51.9% female, mean age of 73 ± 17 years, 90.4% with neurological dysphagia and 9.6% with tumors compromising oral intake. The median survival time was 272 days. The 30-day, 90-day and 180-day mortality was 0.14 ± 0.06 (95% CI 0.08-0.20), 0.29 ± 0.08 (95% CI 0.21-0.37) and 0.43 ± 0.08 (95% CI 0.35-0.51), respectively. Patients with higher levels CPR (hazard ratio (HR) 1.009 95% CI 1.002-1.160, p = 0.012) and higher levels of urea (HR 1.009 95% CI 1.002-1.160, p = 0.012) had worse outcome and those with higher sodium levels (HR 0.945 95% CI 0.908-0.983, p = 0.005) had better prognosis. Higher CRP levels was the only independent predictive factor for 30-day mortality (odds ratio (OR) 1.008 95% CI 1.001-1.014, p = 0.029), and was also a risk factor for 90-day and 180-day mortality (OR 1.013 95% CI 1.005-1.021, p = 0.002 and OR 1.009 95% CI 1.001-1.018, p = 0.026, respectively). CRP levels ≥35.9 mg/dL could predict death at 30 days with a sensitivity of 0.810 and a specificity of 0.614.

CONCLUSIONS

The early mortality after PEG placement is high. CRP, an indicator of acute illness, is a useful parameter at identifying patients with increased probability of dying after PEG insertion. High CRP levels should be considered in the decision making process.

Authors+Show Affiliations

Gastroenterology Department, Centro Hospitalar do Alto Ave - Guimarães - Portugal, Rua dos Cutileiros, 4835 044 Guimarães, Portugal. Electronic address: maraisabelbarbosa@net.sapo.pt.Gastroenterology Department, Centro Hospitalar do Alto Ave - Guimarães - Portugal, Rua dos Cutileiros, 4835 044 Guimarães, Portugal. Electronic address: joanaltmagalhaes@gmail.com.Gastroenterology Department, Centro Hospitalar do Alto Ave - Guimarães - Portugal, Rua dos Cutileiros, 4835 044 Guimarães, Portugal. Electronic address: mouramarinho@hotmail.com.Gastroenterology Department, Centro Hospitalar do Alto Ave - Guimarães - Portugal, Rua dos Cutileiros, 4835 044 Guimarães, Portugal. Electronic address: jabcotter@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28531394

Citation

Barbosa, Mara, et al. "Predictive Factors of Early Mortality After Percutaneous Endoscopic Gastrostomy Placement: the Importance of C-reactive Protein." Clinical Nutrition ESPEN, vol. 14, 2016, pp. 19-23.
Barbosa M, Magalhaes J, Marinho C, et al. Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. Clin Nutr ESPEN. 2016;14:19-23.
Barbosa, M., Magalhaes, J., Marinho, C., & Cotter, J. (2016). Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. Clinical Nutrition ESPEN, 14, 19-23. https://doi.org/10.1016/j.clnesp.2016.04.029
Barbosa M, et al. Predictive Factors of Early Mortality After Percutaneous Endoscopic Gastrostomy Placement: the Importance of C-reactive Protein. Clin Nutr ESPEN. 2016;14:19-23. PubMed PMID: 28531394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. AU - Barbosa,Mara, AU - Magalhaes,Joana, AU - Marinho,Carla, AU - Cotter,Jose, Y1 - 2016/05/17/ PY - 2016/01/15/received PY - 2016/03/09/revised PY - 2016/04/23/accepted PY - 2017/5/23/entrez PY - 2017/5/23/pubmed PY - 2018/1/25/medline KW - C-reactive protein KW - Early mortality KW - Percutaneous endoscopic gastrostomy SP - 19 EP - 23 JF - Clinical nutrition ESPEN JO - Clin Nutr ESPEN VL - 14 N2 - INTRODUCTION AND AIMS: Percutaneous endoscopic gastrostomy (PEG) is considered one of the preferred routes for long-term enteral feeding. However, early mortality after PEG placement is high. We aimed at analyzing overall and early mortality in patients who underwent PEG insertion and at identifying risk factors of increased mortality after the procedure. METHODS: Retrospective study which included patients who had a PEG insertion at our department between May 2007 and January 2013. Variables analyzed: demographic, Charlson's co-morbidity index, past aspiration pneumonia, indication for PEG, hemogram, ionogram, urea, creatinine, albumin and C-reactive protein (CRP). OUTCOME: death. Kaplan-Meier survival analysis was used to calculate mortality after PEG placement. Predictive factors of overall mortality were identified by univariate and multivariate analysis and of 30-day, 90-day and 180-day mortality by logistic regression. The AUROC analysis for CRP levels was performed. RESULTS: Inclusion of 135 patients: 51.9% female, mean age of 73 ± 17 years, 90.4% with neurological dysphagia and 9.6% with tumors compromising oral intake. The median survival time was 272 days. The 30-day, 90-day and 180-day mortality was 0.14 ± 0.06 (95% CI 0.08-0.20), 0.29 ± 0.08 (95% CI 0.21-0.37) and 0.43 ± 0.08 (95% CI 0.35-0.51), respectively. Patients with higher levels CPR (hazard ratio (HR) 1.009 95% CI 1.002-1.160, p = 0.012) and higher levels of urea (HR 1.009 95% CI 1.002-1.160, p = 0.012) had worse outcome and those with higher sodium levels (HR 0.945 95% CI 0.908-0.983, p = 0.005) had better prognosis. Higher CRP levels was the only independent predictive factor for 30-day mortality (odds ratio (OR) 1.008 95% CI 1.001-1.014, p = 0.029), and was also a risk factor for 90-day and 180-day mortality (OR 1.013 95% CI 1.005-1.021, p = 0.002 and OR 1.009 95% CI 1.001-1.018, p = 0.026, respectively). CRP levels ≥35.9 mg/dL could predict death at 30 days with a sensitivity of 0.810 and a specificity of 0.614. CONCLUSIONS: The early mortality after PEG placement is high. CRP, an indicator of acute illness, is a useful parameter at identifying patients with increased probability of dying after PEG insertion. High CRP levels should be considered in the decision making process. SN - 2405-4577 UR - https://www.unboundmedicine.com/medline/citation/28531394/Predictive_factors_of_early_mortality_after_percutaneous_endoscopic_gastrostomy_placement:_The_importance_of_C_reactive_protein_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4577(16)30208-X DB - PRIME DP - Unbound Medicine ER -