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RISK FACTORS ASSOCIATED WITH EARLY MORTALITY AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PATIENTS AT A TERTIARY CARE
Luiz Eduardo Miranda1, Marcel Rolland Ciro da Penha1, Ana Clara Galindo Miranda2
1Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia Geral e Transplante Hepático, Recife, PE, Brasil.
Insights
Low hemoglobin and pre-procedure ICU stay are key risk factors for early mortality after percutaneous endoscopic gastrostomy (PEG) procedures. Identifying these factors can help improve patient outcomes and reduce mortality rates.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Internal Medicine
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a standard procedure for long-term nutritional support.
- Understanding factors influencing early mortality post-PEG is crucial for patient management.
Purpose of the Study:
- To identify risk factors associated with early mortality following percutaneous endoscopic gastrostomy (PEG) placement.
- To analyze the impact of pre-existing conditions and pre-procedure status on PEG outcomes.
Main Methods:
- Retrospective survival analysis of 150 patients undergoing PEG placement.
- Kaplan-Meier method and multivariable Cox proportional regression models were employed.
- Analysis focused on identifying significant predictors of early mortality.
Main Results:
- The 30-day and 60-day mortality rates were 11.05% and 15.34%, respectively.
- Low hemoglobin levels (HR 4.39) and pre-procedure ICU stay (HR 0.66) were significant predictors of early mortality.
- A hemoglobin cutoff of 10.05 g/dL showed predictive value for mortality.
Conclusions:
- Low hemoglobin and pre-procedure intensive care unit (ICU) internment are significant risk factors for early mortality after PEG.
- These findings highlight the importance of optimizing patient condition prior to PEG placement.
- Further research may focus on interventions to mitigate these risks.
Background:
Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding.
Objective:
To investigate the risk factors associated with early mortality after PEG.
Methods:
Retrospective survival analysis in a tertiary-level center in Recife, Brazil. We reviewed the medical records of 150 patients with PEG placement. The data were analysed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality.
Results:
A total of 150 patients who submitted to PEG were studied (70 male). Of the participants, 87 (58%) had blood hypertension; 51 (34%) patients had diabetes; 6 (4%) patients had chronic renal disease; and 6 (4%) had malignancy. Chronic neurodegenerative diseases were the more common clinical indication for PEG. The 30-day and 60-day proportional mortality probability rates were 11.05% and 15.34% respectively. A multivariate Cox proportional regression model, haemoglobin (HR 4.39, 95%CI 1.30-14.81, P=0.017) and pre-procedure UCI staying (HR 0.66, 95% CI 0.50-0.87, P=0.004) were significant predictors of early mortality.A haemoglobin cut-off value of 10.05 g/dL was shown to have a sensibility of 82.6% (61.2% to 95% CI) and an acceptable sensitivity of 59.0 (50.6% to68.6% CI), and a likelihood ratio of 2.06 for eight weeks mortality.
Conclusion:
In patients who had been subjected to the PEG procedure for long-term nutrition, low haemoglobin, pre-procedure intensive care unit internment or both are associated with the risk of early mortality.
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