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

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• 作者：Rosangela Muratori^a ; Andrea Lisotti^b ; ^{lisotti.andrea@gmail.com} ; Pietro Fusaroli^b ; Alessandra Caponi^a ; Giulia Gibiino^a ; Leonardo Henry Eusebi^a ; Francesco Azzaroli^a ; Nicole Brighi^a ; Guglielmo Altimari^c ; Franco Bazzoli^a
• 关键词：Cancer ; Dementia ; Dysphagia ; Palliative care ; Survival ; Swallowing disorders
• 刊名：Digestive and Liver Disease
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：49
• 期：2
• 页码：181-187
• 全文大小：786 K
• 卷排序：49

文摘

Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life.AimTo evaluate risk factors for early and delayed mortality after gastrostomy placement.MethodsA 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.ResultsAnalysis 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&#xA0;± 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.DiscussionPresence 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.