Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan
Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan
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DOI：
10.3748/wjg.v16.i40.5084
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发表时间：
2010-10-28
影响因子：
4.3
通讯作者：
Urashima, Mitsuyoshi
中科院分区：
文献类型：
--
作者：
Suzuki, Yutaka;Tamez, Seryna;Urashima, Mitsuyoshi
目的：探讨日本经皮内镜胃造口术（PEG）治疗的老年患者的长期生存率。方法：我们回顾性地纳入46家日本社区和三级医院，调查2005年1月1日至2008年12月31日期间931例吞咽困难并新行PEG的连续老年患者（65岁）。我们将死亡作为结局，并使用log-rank检验和Cox比例风险模型探讨PEG患者特征之间的关联。结果：931例患者被随访，中位时间为468 d。共观察到502例死亡（死亡率53%）。然而;931例患者中，存活时间分别超过7天、30天、60天、半年和1年的患者占99%、95%、88%、75%和66%。50%和25%的患者分别存活753和1647 d。8例死亡被认为与peg相关，并与血清白蛋白水平降低相关（P = 0.002）。另一方面，28例存活患者（6.5%）切除了PEG。在多变量风险模型中，老年人[风险比（HR）， 1.02；95%置信区间（CI）， 1.00-1.03；P = 0.009]，较高的c反应蛋白（HR, 1.04, 95% CI: 1.01-1.07, P = 0.005）和较高的血尿素氮（HR, 1.01, 95% CI: 1.00-1.02, P = 0.003）是显著的不良预后因素，而较高的白蛋白（HR, 0.67, 95% CI: 0.52-0.85, P = 0.001）、女性（HR, 0.60, 95% CI: 0.48-0.75, P < 0.001）和无缺血性心脏病史（HR, 0.69, 95% CI: 0.54-0.88, P = 0.003）是显著的预后良好因素。结论：这些结果表明，超过一半的老年PEG患者可能存活超过2年。分析阐明了预后因素。(C) 2010年白石登。版权所有。
AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan.METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient's characteristics at PEG using log-rank tests and Cox proportional hazard models.RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However; 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors.CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors. (C) 2010 Baishideng. All rights reserved.