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Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a
John Blomberg1, Pernilla Lagergren, Lena Martin
1Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. john.blomberg@karolinska.se
Insights
Low albumin and high C-reactive protein (CRP) levels significantly increase short-term mortality risk after percutaneous endoscopic gastrostomy (PEG) procedures. This finding is crucial for patient risk assessment and decision-making before PEG insertion.
Area of Science:
- Medical procedures
- Gastroenterology
- Patient outcomes
Background:
- Percutaneous endoscopic gastrostomy (PEG) is associated with potentially severe complications.
- Identifying risk factors for PEG complications is essential for improving patient counseling and care.
Purpose of the Study:
- To determine if patient factors including age, body mass index, albumin, and C-reactive protein (CRP) levels influence mortality or peristomal infection risk after PEG insertion.
Main Methods:
- A prospective cohort study was conducted from 2005 to 2009 at a university hospital.
- The study included 484 patients undergoing PEG, with follow-up for 14 days post-procedure.
- Outcomes assessed were 30-day mortality and 14-day peristomal infection, with risk estimates adjusted for confounding factors.
Main Results:
- A total of 58 (12%) patients died within 30 days of PEG insertion.
- Factors associated with increased mortality included low albumin (<30 g/L), high CRP (≥10), and age (≥65 years).
- Patients with both low albumin and high CRP levels faced a significantly higher adjusted mortality risk (HR, 7.45; 95% CI, 2.62-21.19), with a 20.5% mortality rate compared to 2.6% in those with normal levels.
Conclusions:
- The combination of low albumin and high CRP levels is a strong indicator of substantially increased short-term mortality risk following PEG.
- These biochemical markers should be considered in the clinical decision-making process for patients referred for PEG placement.
Background:
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.
Objective:
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.
Design:
Prospective cohort study from 2005 to 2009. Follow-up 14 days after PEG.
Setting:
University hospital.
Patients:
This study involved 484 patients referred for PEG.
Intervention:
PEG.
Main Outcome Measurements:
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.
Results:
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).
Limitations:
Missing data in some study variables. Although the sample size was large, weaker associations could not be established.
Conclusion:
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.
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