Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio

Abstract

Background and study aims: Percutaneous endoscopic gastrostomy (PEG) is a procedure that provides long term enteral nutrition. To investigate the predictors of PEG-related complications and 30-day mortality rates and evaluate the indicators for deciding whether to recommend elective PEG insertions, we sought to determine the complications and early mortality rates of patients who underwent PEG. Patients and methods: We performed a retrospective analysis of consecutive adult patients who had undergone PEG for the first time between October 2016 and January 2019. The predictors of complications and 30-day mortality were analyzed with receiver operating characteristic (ROC) and logistic regression analysis. Results: This study included 309 patients. Patients were excluded from the study if they were < 18 years of age or there were missing data about them. Out of 253 patients, 33 (13%) had complications and 32 (12.6%) died within one month after PEG insertion. A higher C-reactive protein (CRP) to albumin ratio was the only independent factor predicting the complications (odds ratio (OR) : 3.17 ; 95% CI : 1.26-8.00 ; p = 0.014). The independent predictive factors for 30-day mortality after PEG placement included higher urea levels and higher CRP to albumin ratios (OR : 3.78 ; 95% CI : 1.41-10.17 ; p = 0.008) (OR : 6.67 ; 95% CI : 1.87- 23.75 ; p = 0.003). The only predictor for both complications and 30-day mortality was the CRP to albumin ratio. Conclusions: When appropriate, the PEG procedure can provide a safe and effective method for enteral feeding. The CRP to albumin ratio can be used to predict complications and early mortality after PEG insertion. Because PEG is elective, higher CRP to albumin ratios can be helpful in deciding to select patients for the procedure.

Preprocedural control of nutritional status score and prediction of early death after percutaneous endoscopic gastrostomy

“…Inflammation, which may be caused by chronic disease or uncontrolled infection, is reported to be associated with poor prognosis. Poor nutritional status, such as anemia and high BUN, is also associated with poor prognosis 5,7 . Although consistent results may not be obtained when a single parameter is assessed, new insights may be obtained by combining several parameters that reflect protein reserves, immune status, and lipid metabolism, as in the CONUT score.…”

“…Poor nutritional status, such as anemia and high BUN, is also associated with poor prognosis. 5 , 7 Although consistent results may not be obtained when a single parameter is assessed, new insights may be obtained by combining several parameters that reflect protein reserves, immune status, and lipid metabolism, as in the CONUT score. Although various internal and external factors contribute to early mortality after PEG that cannot be simply quantified, the results of the present study indicate that the CONUT score may have utility in identifying patients at risk of early mortality after PEG.…”

“…Evaluated parameters included patient background such as age, sex, underlying diseases, serological tests, and PEG placement time. Serological data included white blood cell count, lymphocyte count, hemoglobin, platelets, albumin, blood urea nitrogen (BUN), C‐reactive protein (CRP), and CRP/albumin ratio before PEG, based on previous reports 5–10 . Serological results from blood samples taken on the day of PEG or the day before were used.…”

“…Serological data included white blood cell count, lymphocyte count, hemoglobin, platelets, albumin, blood urea nitrogen (BUN), C-reactive protein (CRP), and CRP/albumin ratio before PEG, based on previous reports. [5][6][7][8][9][10] Serological results from blood samples taken on the day of PEG or the day before were used. In addition, the prognostic nutritional index (PNI) developed by Onodera et al 18 (Table 1) and the CONUT score 16 (Table 2), which are based on serological results only, were used to evaluate nutritional status.…”

“…PEG is a minimally invasive procedure compared to surgical gastrostomy but has recognized complications that include mortality. 1 , 2 , 3 , 4 Previous studies have identified certain pre‐existing medical conditions and serological tests as prognostic factors for early mortality after PEG 5 , 6 , 7 , 8 , 9 , 10 ; however, these results have been inconsistent between studies. Other studies have reported that preoperative nutritional status is associated with prognosis in patients undergoing gastrointestinal surgery.…”