Prognostic nutritional index and early mortality with percutaneous endoscopic gastrostomy

Adachi, Yasushi; Akino, Kimishige; Nojima, Masanori; Himori, Ryogo; Kikuchi, Takefumi; Mitsuya, Hiroaki; Nakamura, Masafumi; Tsukuda, Hiroyuki; Yamano, Hiro‐o; Sasaki, Yasushi; Yoshida, Yuta; Kato, Yuko; Nakase, Hajime; Endo, Takao

doi:10.1093/qjmed/hcy137

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Although there were some missing data and both the complete case analysis and the multiple imputation analysis were performed, the results were robust. Since TLC and BMI are major nutritional assessment items [7,8,21,25,26], AWT can be defined as a variable indicative of nutritional status. Although the association between AWT and nutritional status has not been fully validated in previous studies, our study has demonstrated the validity of using AWT as a nutritional indicator.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to lower AWT being associated with lower BMI and malnutrition [11]. A better nutritional status is important for better survival [7,9,10,15,21]. Therefore, AWT may help assess nutritional status and predict survival in dysphagic patients with PEG.…”

Section: Discussionmentioning

confidence: 99%

“…A lower BMI is associated with an increased risk of mortality after PEG [9]. Serum albumin (Alb) and total lymphocyte count (TLC), which are indicators of nutritional status, are also prognostic factors after PEG [7,10]. Therefore, assessment of nutritional status is crucial for better nutritional intervention and improving patient prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia

Masaki

Kimura

2021

Clinical Nutrition ESPEN

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Background & aims: The significance of abdominal wall thickness (AWT) for nutritional assessment remains unclear. This study aimed to evaluate the nutritional and prognostic significance of AWT measured during percutaneous endoscopic gastrostomy (PEG) in older patients with dysphagia. Methods: This single-center retrospective cohort study enrolled older adults with dysphagia who underwent PEG for enteral nutrition using the introducer technique between February 2010 and January 2019. We examined the association between AWT measured during PEG and nutritional status items, including body mass index (BMI), serum albumin (Alb), total lymphocyte count (TLC), total cholesterol (TC), hemoglobin (Hb), and C-reactive protein (CRP). The shaft length of the PEG tube inserted, which is an approximation value of the AWT, was used for statistical analysis. Patients were divided into three groups: low-AWT group (shaft length 2.5 cm), medium-AWT group (shaft length 3.0e3.5 cm), and high-AWT group (shaft length !4.0 cm). We performed the KruskaleWallis test and multiple linear regression analysis with multiple imputation. We performed survival analysis using the KaplaneMeier method, log-rank test, and Cox regression analysis. Results: A total of 520 patients were identified: 115, 258, and 147 patients in the low-AWT, medium-AWT, and high-AWT groups, respectively. Higher AWT was significantly associated with higher BMI, Alb, TLC, TC, Hb, and lower CRP levels. Multiple linear regression analysis revealed that BMI and TLC were significant predictors of AWT (BMI: coefficient 1.16E-01, 95% confidence interval [CI], 9.77E-02e1.33E-01, P < 0.001; TLC: coefficient 1.18E-04, 95% CI, 2.72E-05e2.09E-04, P ¼ 0.011). The median survival time was the longest in the high-AWT group (low-AWT, 359 days; medium-AWT, 851 days; high-AWT, 1662 days; P < 0.001). The hazard ratio for the high-AWT group relative to the medium-AWT group was 0.59 (95% CI, 0.41e0.85, P ¼ 0.004), and that relative to the low-AWT group was 0.34 (95% CI, 0.24e0.51, P < 0.001). Conclusions: Higher AWT was associated with better nutritional status and survival. AWT may help assess nutritional status and predict survival in older dysphagic patients with PEG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia

Masaki

Kimura

2021

Clinical Nutrition ESPEN

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“…It is calculated based on the serum albumin concentration and peripheral blood lymphocyte count (10× serum albumin concentration g/dL + 0.005 × total peripheral lymphocyte count per mm 3 ). The PNI allows for the automatic daily assessment of the nutritional status of all in‐patients that undergo a routine analysis 9,10 …”

Section: Methodsmentioning

confidence: 99%

Complications in patients with neurological impairment after gastrostomy

Sakamoto

Hashizume

Fukahori

et al. 2021

Pediatrics International

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Background Neurological impairment (NI) is responsible for most conditions that require a permanent gastrostomy tube. The present study assessed the occurrence of short‐ and long‐term complications after video‐assisted gastrostomy (VAG) in patients with NI. Methods The incidence of short‐ (<6 months) and long‐term (over 2 years) complications of VAG were analyzed in a retrospective study. The differences between the incidence of the complications of VAG according to the age at surgery (≤15 years vs. ≥16 years) were also evaluated. The short‐ and long‐term complications observed were granulation tissue formation, infection requiring antibiotic treatment, skin problems, perigastrostomy leakage, vomiting, accidental tube dislodgement, dumping syndrome, ileus, and peritonitis. Results Eighty‐two patients were evaluated for short‐ and long‐term complications. The long‐term complication rate was significantly lower than the short‐term complication rate (P = 0.0026). Onodera’s prognostic nutritional index before VAG in patients with long‐term complications was significantly lower than in patients without such complications (P = 0.046). The incidence of long‐term granulation tissue formation, infection, and vomiting were significantly lower than those of similar short‐term complications. Long‐term skin problems were associated with short‐term skin problems (odds ratio: 18.95; 95% confidence interval: 4.53–92.98; P < 0.001). The number of patients ≥16 years old with short‐ and long‐term skin problems was significantly higher than in patients ≤15 years old (P = 0.0014 and P = 0.0073, respectively). Conclusions The incidence rate of granulation tissue formation and infection after VAG were lower in the long term than in the short term. However, patients ≥16 years old presented with persistent complications.

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“…rospective cohort showed an early mortality rate of 5.2% and a median survival of 801 days after PEG(23). Arora et al showed that each year of increase in age increased risk of death by 1% among PEG recipients…”

mentioning

confidence: 99%

Survival Following Percutaneous Endoscopic Gastrostomy in Neurology Intensive Care Unit Patients

BEREKETOĞLU

Haki

2023

Harran Üniversitesi Tıp Fakültesi Dergisi

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Background: We aimed to determine factors affecting mortality and survival after Percutaneous endoscopic gastrostomy (PEG) in patients who were hospitalized in the neurology intensive care unit during the coronavirus disease-2019 (COVID-19) pandemic Materials and Methods: The clinical and demographic data of 29 patients aged 18 years and older who received PEG tube insertion during hospitalization in the Neurology Intensive Care Unit of XXX Hospital, Turkey, between February 2020 and May 2021 were examined retrospectively. Patients’ demographics, clinical characteristics, and survival status were recorded. Results: We included 29 patients (16 females and 13 males) into our study. Median age was 71 (33–89) years among survivors and 75.5 (48–90) years among those who died. The groups were similar with respect to age (p = 0.119) and sex (p = 0.806). Mortality rate after PEG insertion was 66%. Mean overall survival after PEG tube insertion was 129.49 days (95% CI: 91.21–167.78). Cox regression revealed that having multiple comorbidities increased the likelihood of mortality by 2.822-fold (95% CI: 1.001–7.968, p = 0.049). Conclusions: These findings show that having multiple comorbidities was the most important factor associated with mortality among PEG recipients who were admitted to the Neurology Intensive Care Unit during the COVID-19 pandemic. Since multiple comorbidities cause shorter survival, it appears that the decision to insert PEG tubes must be made extremely cautiously among these patients. However, more comprehensive studies should be conducted to clarify the effect of COVID-19 on mortality rates and survival time after PEG.

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Prognostic nutritional index and early mortality with percutaneous endoscopic gastrostomy

Abstract: Nutritional status might be a predictive factor for early mortality after PEG. In patients with poor nutritional status, nutritional supporting period before PEG might improve the outcomes and reduce unnecessary PEG.

Cited by 5 publications

References 23 publications

Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia

Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia

Complications in patients with neurological impairment after gastrostomy

Survival Following Percutaneous Endoscopic Gastrostomy in Neurology Intensive Care Unit Patients

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