Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement. Issue 2 (February 2017)

• Record Type: Journal Article
• Authors: Muratori, Rosangela; Lisotti, Andrea; Fusaroli, Pietro; Caponi, Alessandra; Gibiino, Giulia; Eusebi, Leonardo Henry; Azzaroli, Francesco; Brighi, Nicole; Altimari, Guglielmo; Bazzoli, Franco
• Is Part Of: Digestive and liver disease. Volume 49:Issue 2(2017)
• Page Start: 181
• Page End: 187
• Publication Date: 2017-02
• Subjects: Cancer -- Dementia -- Dysphagia -- Palliative care -- Survival -- Swallowing disorders; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2016.10.015
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life. Aim: To evaluate risk factors for early and delayed mortality after gastrostomy placement. Methods: 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. Results: 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 ± 3.4 months; 1-month and 3-month mortality rates were 4.0% and 8.1%, respectively. Severe hypernatremia (≥150 mmol/L) was independently related to 1-month mortality (odds ratio 25.4; P < 0.0001), while C-reactive protein level > 4.3 mg/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 > 4.3 mg/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. Discussion: 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.