Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein

Barbosa, Mara; Magalhães, Joana; Marinho, Carla; Cotter, José

doi:10.1016/j.clnesp.2016.04.029

Cited by 20 publications

(11 citation statements)

References 19 publications

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“…In this study, a comparison of baseline characteristics between the groups before propensity score matching revealed that patients with greater age, lower serum albumin levels, higher C-reactive protein levels, and severe dementia were more likely to receive TPN. Greater age, lower serum albumin levels, higher C-reactive protein levels, and severe dementia were reported as poor prognostic factors after PEG [5,6,20–22]. Our results indicated that PEG tended to be avoided in patients with such poor prognostic factors, and as a result, TPN was chosen as the alternative modality for artificial nutrition.…”

Section: Discussionmentioning

confidence: 70%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Masaki

Kawamoto

2019

PLoS ONE

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BackgroundThe long-term outcomes of artificial nutrition in older people with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) is one of the major methods of artificial nutrition. Enteral feeding is indicated for patients with a functional gastrointestinal tract. However, total parenteral nutrition (TPN) is often inappropriately chosen for artificial nutrition in Japan, even in patients with a functional gastrointestinal tract, as PEG has recently been viewed as an unnecessary life-prolonging treatment in Japan. This study aimed to compare the long-term outcomes between PEG and TPN.MethodsThis single-center retrospective cohort study investigated long-term outcomes in older patients with dysphagia who received PEG or TPN between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed 1-to-1 propensity score matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and Cox regression analysis were used to compare the survival time between groups.ResultsWe identified 253 patients who received PEG (n = 180) or TPN (n = 73). Older patients, those with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P = 0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39–0.92; P = 0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P = 0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P = 0.018).ConclusionsPEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN.

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Section: Discussionmentioning

confidence: 70%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Masaki

Kawamoto

2019

PLoS ONE

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“…Whereas higher BMI was protective for 30-day mortality, age and comorbidities (such as DM, cirrhosis, cancer, chronic obstructive pulmonary disease) were not risk factors for 30-day mortality in our analysis. Previous literature, however, reported all these factors as predictive factors for 30-day mortality 34 35 36 37 38 .…”

Section: Discussionmentioning

confidence: 93%

Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications

Strijbos

Keszthelyi

Gilissen³

et al. 2019

Endosc Int Open

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Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates. Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG ( P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG ( P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG ( P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates. Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ. Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.

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“…Similarly, low concentration of albumin was shown to be associated with poor outcome and higher mortality [12, 14–16]. Moreover, several studies have demonstrated that high serum CRP levels [17, 18] and low serum albumin levels [18, 19] were associated with short-term mortality. Serum CRP-to-albumin ratio has been shown previously to be a predictor for overall survival in several cancer states [20] and in coronary artery disease [21].…”

Section: Discussionmentioning

confidence: 99%

Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion

Sbeit¹,

Kadah

Mari

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Background Percutaneous endoscopic gastrostomy (PEG) tube insertion is an increasingly used minimally invasive method for long-term enteral feeding. Identification of simple predictors for short-term mortality (up to one month) after PEG insertion is of paramount importance. Aim We aimed to explore a simple noninvasive parameter that would predict survival following PEG insertion. Methods We performed a retrospective study of all patients who underwent PEG insertion at the Galilee Medical Center from January 1, 2014 to December 30, 2018. We collected simple clinical and laboratory parameters and survival data and looked for predictors of short-term mortality. Results A total of 272 patients who underwent PEG insertion were included. Sixty-four patients (23.5%) died within one month after PEG insertion compared to 208 patients (76.5%) who survived for more than one month. Univariate analysis revealed several short-term mortality-related predictors, including older age (OR 1.1, P=0.005), ischemic heart disease (OR 2, P=0.0197), higher creatinine level (OR 2.3, P=0.0043), and elevated CRP level and CRP-to-albumin ratio (OR 1.1, P < 0.0001; OR 1.0031, P < 0.0001, respectively). In multivariate logistic analysis, older age (OR 1.1, P=0.019), higher creatinine level (OR 1.6, P=0.074), and elevated CRP-to-albumin ratio (OR 1.1, P=0.002) remained significant predictors of short-term mortality after PEG insertion with an ROC of 0.7274. Conclusion We could identify several simple parameters associated with high risk of mortality, and we recommend considering using these parameters in decision-making regarding PEG insertion. Further prospective studies are needed to validate our findings.

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Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein

Cited by 20 publications

References 19 publications

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications

Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion

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