Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement

Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life.

To evaluate risk factors for early and delayed mortality after gastrostomy placement.

A single-center retrospective analysis of a prospectively-collected database including all patients undergoing gastrostomy placement for enteral nutrition was performed. Two operators performed all the procedures according to the most recent guidelines.

Analysis included data on 438 patients [178 male; 80.5 (72-86) year-old]. Indications for PEG were stroke (34.0%), dementia (31.3%), neurodegenerative disorders (18.5%), coma (9.1%) and cancer (7.1%). No periprocedural adverse events was observed. Mean survival was 14.6±3.4months; 1-month and 3-month mortality rates were 4.0% and 8.1%, respectively. Severe hypernatremia (≥150mmol/L) was independently related to 1-month mortality (odds ratio 25.4; P<0.0001), while C-reactive protein level>4.3mg/dL was independently related to 3-month mortality (odds ratio 5.3; P=0.003). Kaplan-Meier and Cox-regression analysis identified male gender (hazard ratio 2.32; P=0.0002), severe hypernatremia (hazard ratio 4.3; P<0.0001), C-reactive protein>4.3mg/dL (hazard ratio 3.5; P=0.0014), leukocytosis (hazard ratio 1.97; P=0.0036) and presence of underlying malignancy (hazard ratio 2.4; P=0.0013) as independent risk factors for long-term mortality.

Presence of severe hypernatremia and increased C-reactive protein levels were strongly correlated with early and delayed mortality in our population. Studies are necessary to understand whether correcting underlying dehydration and inflammation further improves patients' outcomes.