Prognostic Factors of One-Month Mortality After Percutaneous Endoscopic Gastrostomy and Advantages of the Introducer Technique

Abstract

Background: Indications for PEG are dysphagia or anorexia due to neurological impairment, dementia or malignancy. Admittedly PEG is recommended for those who are expected to survive more than one month after PEG placement. Meanwhile one-month mortality is of wide range (9%-42%). Some parameters seem to be associated with this outcome. The aim of this study was to prospectively assess these parameters. Method: Dysphagic or anorexic patients admitted between January 2000 and November 2003 were eligible for this study. All indications (mostly dysphagia) for PEG were discussed and accepted by attending physicians. Enteral nutrition (800-1200 kcal/day)was initiated on the third day after PEG. Prophylactic antibiotics were administered for 3 days. Prognostic factors were prospectively collected and compared between the patients who died within one month after PEG and the rest who survived more than one month. Demographic data; age, gender, Charlson comorbidity index, nutrition-related parameters (albumin, hemoglobin, cholesterol), Barthel index (functional status), serum CRP level(inflammation index), positive rate for MRSA and PEG techniques (the introducer technique modified by Funada or the pull technique) Results: 122 PEGs were placed in 46 men and 76 women. (mean age 78.2±4.5 years, range 48-102 years of age). Thirteen patients (11%, group A:5 men and 8 women) died within one month after PEG and the rest 109 patients (89%, group B) survived more than one month. Causes of death were pneumonia in 9 cases and others in 4 cases (2 apoplexy, 1 cancer, 1 sepsis). As to demographic data, age and gender:no significance, Alb(g/dl); group A vs. group B=2.8 vs. 3.4(p≤0.02), Hb(g/dl); 10.2 vs. 11.4(NS), Chol(mg/dl); 142 vs. 152(NS), CRP(mg/dl); 7.2 vs. 2.2 (p≤0.03), Charlson comorbidity index; 4.3 vs. 3.1 (p≤0.03), mean Barthel index; less than 10 pt. vs. less than 10 pt.(NS), positive rate for MRSA:0.62 vs. 0.31 (p≤0.05) and all 13 cases of group A (1 case placed by the introducer technique and 12 cases by the pull one) vs. the other 109 cases of group B (both 39 cases placed by the introducer technique and 70 cases by the pull one) (p≤0.05). Conclusion: As for prognostic factors of one-month mortality after PEG, Charlson comorbidity index (≥4), high serum CRP level (≥7mg/dl), low serum albumin level (≤2.8g/dl) and MRSA positive may be correlated with one-month mortality. Furthermore the introducer technique may reduce a short-term mortality after PEG and it also has the advantage of low cost.