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Pre-procedural predictors of in-hospital mortality in ICU patients undergoing endoscopic PEG placement
Mustafa Oruç1, Eda Şahingöz1, Ece Canpolat1
1Clinic of General Surgery, Ankara Bilkent City Hospital, Ankara, Türkiye.
Insights
Percutaneous endoscopic gastrostomy (PEG) in the ICU is high-risk. Active infection, low albumin, and high urea predict in-hospital mortality after PEG placement, aiding patient selection.
Area of Science:
- Medical Research
- Gastroenterology
- Critical Care Medicine
Background:
- Percutaneous endoscopic gastrostomy (PEG) is crucial for enteral nutrition in patients with impaired oral intake.
- PEG placement in the intensive care unit (ICU) carries substantial short-term mortality risks.
- Identifying mortality predictors is vital for optimizing patient selection and care.
Purpose of the Study:
- To identify independent predictors of in-hospital mortality in intensive care unit (ICU) patients undergoing percutaneous endoscopic gastrostomy (PEG).
Main Methods:
- Retrospective cohort study of 364 adult ICU patients undergoing PEG from 2019-2024.
- Analysis of demographic, clinical, laboratory, and procedural data.
- Logistic regression models used to determine independent predictors of in-hospital mortality.
Main Results:
- In-hospital mortality occurred in 34.3% of patients (125/364).
- Non-survivors had lower albumin, higher urea, higher neutrophil-lymphocyte ratio, and more frequent active infection at PEG placement.
- Multivariate analysis identified active infection (OR 3.62), lower albumin (OR 0.90), and higher urea (OR 1.02) as independent predictors of mortality.
Conclusions:
- Active infection, severe hypoalbuminemia, and elevated urea levels significantly increase in-hospital mortality risk post-PEG in ICU patients.
- Prolonged mechanical ventilation may indicate patient frailty rather than being an independent predictor.
- Integrating these markers into pre-procedural assessments can enhance patient selection and decision-making for ICU PEG placement.
Objective:
Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in patients unable to maintain oral intake. However, PEG placement is already considered a high-risk intervention in the intensive care unit (ICU), where short-term mortality is substantial. This study aimed to identify predictors of in-hospital mortality in ICU patients undergoing PEG.
Material And Methods:
A retrospective cohort study was conducted at a single tertiary center from 2019 to 2024, including all consecutive adult ICU patients who underwent endoscopic PEG. Demographic, clinical, laboratory, and procedural data were analyzed. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used to identify independent predictors.
Results:
A total of 364 ICU patients underwent PEG, of whom 125 (34.3%) died during the index hospitalization. Among non-survivors, 56 (44.8%) died within the first 14 days after PEG placement. Non-survivors showed lower albumin levels (24.4 vs. 28.2 g/L; p<0.001), higher urea concentrations (57.1 vs. 40.6 mg/dL; p<0.001), higher neutrophil-lymphocyte ratio (6.44 vs. 4.81; p=0.002), and more frequent infection at the time of PEG (88% vs. 58.6%; p<0.001). Prolonged mechanical ventilation (>14 days) was more common among non-survivors (23.2% vs. 11.7%; p=0.005). In the multivariate model, active infection [odds ratio (OR) 3.62; p<0.001], lower albumin (OR 0.90 per g/L; p<0.001), and higher urea (OR 1.02; p=0.05) independently predicted in-hospital mortality, whereas prolonged intubation showed a strong trend but did not reach significance (OR 1.85; p=0.06).
Conclusion:
ICU patients with active infection, severe hypoalbuminemia, and elevated urea levels have a markedly increased risk of in-hospital mortality after PEG placement. Prolonged mechanical ventilation appears to characterize a clinically more fragile ICU population rather than serving as an independent predictor of mortality. Incorporating these objective markers into pre-procedural assessments may improve patient selection and support decision-making in the ICU.
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