Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein.
Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein.
复制标题
经皮内镜胃造口术后早期死亡的预测因素：C反应蛋白的重要性。
DOI：
10.1016/j.clnesp.2016.04.029
复制
发表时间：
2016
影响因子：
3
通讯作者：
J. Cotter
中科院分区：
文献类型：
--
作者：
M. Barbosa;J. Magalhães;C. Marinho;J. Cotter
经皮内镜胃造口术（PEG）被认为是长期肠道喂养的首选途径之一。然而，PEG放置后的早期死亡率很高。我们的目的是分析接受PEG插入的患者的总体和早期死亡率，并确定手术后死亡率增加的危险因素。MethodsRetrospective研究包括2007年5月至2013年1月在我科进行PEG插入的患者。分析的变量：人口统计学、Charlson共病指数、既往吸入性肺炎、PEG适应症、血象、电离图、尿素、肌酐、白蛋白和C反应蛋白（CRP）。结局：死亡。使用Kaplan-Meier生存分析来计算PEG放置后的死亡率。通过单因素和多因素分析确定总死亡率的预测因素，通过Logistic回归确定30天、90天和180天死亡率的预测因素。AUROC分析CRP levels performed.ResultsInclusion的135例患者：51.9%的女性，平均年龄为73 ± 17岁，90.4%的神经性吞咽困难和9.6%的肿瘤损害口服摄入。中位生存期为272天。30天、90天和180天死亡率分别为0.14 ± 0.06（95% CI 0.08-0.20）、0.29 ± 0.08（95% CI 0.21-0.37）和0.43 ± 0.08（95% CI 0.35-0.51）。心肺复苏水平较高的患者（风险比（HR）1.009 95% CI 1.002-1.160，p = 0.012）和较高水平的尿素（HR 1.009 95% CI 1.002-1.160，p = 0.012）预后较差，高钠水平（HR 0.945 95% CI 0.908-0.983，p = 0.005）预后较好。高CRP水平是30天死亡率的唯一独立预测因素（比值比（OR）1.008 95%CI 1.001-1.014，p = 0.029），也是90天和180天死亡率的危险因素（OR 1.013 95% CI 1.005-1.021，p = 0.002和OR 1.009 95% CI 1.001-1.018，p = 0.026）。CRP水平≥ 35.9mg/dL可预测30 d死亡，其敏感性为0.810，特异性为0.614。CRP是急性疾病的指标，是识别PEG插入后死亡概率增加的患者的有用参数。在决策过程中应考虑高CRP水平。
Introduction and aimsPercutaneous endoscopic gastrostomy (PEG) is considered one of the preferred routes for long-term enteral feeding. However, early mortality after PEG placement is high. We aimed at analyzing overall and early mortality in patients who underwent PEG insertion and at identifying risk factors of increased mortality after the procedure.MethodsRetrospective study which included patients who had a PEG insertion at our department between May 2007 and January 2013. Variables analyzed: demographic, Charlson's co-morbidity index, past aspiration pneumonia, indication for PEG, hemogram, ionogram, urea, creatinine, albumin and C-reactive protein (CRP). Outcome: death. Kaplan–Meier survival analysis was used to calculate mortality after PEG placement. Predictive factors of overall mortality were identified by univariate and multivariate analysis and of 30-day, 90-day and 180-day mortality by logistic regression. The AUROC analysis for CRP levels was performed.ResultsInclusion of 135 patients: 51.9% female, mean age of 73 ± 17 years, 90.4% with neurological dysphagia and 9.6% with tumors compromising oral intake. The median survival time was 272 days. The 30-day, 90-day and 180-day mortality was 0.14 ± 0.06 (95% CI 0.08–0.20), 0.29 ± 0.08 (95% CI 0.21–0.37) and 0.43 ± 0.08 (95% CI 0.35–0.51), respectively. Patients with higher levels CPR (hazard ratio (HR) 1.009 95% CI 1.002–1.160, p = 0.012) and higher levels of urea (HR 1.009 95% CI 1.002–1.160, p = 0.012) had worse outcome and those with higher sodium levels (HR 0.945 95% CI 0.908–0.983, p = 0.005) had better prognosis. Higher CRP levels was the only independent predictive factor for 30-day mortality (odds ratio (OR) 1.008 95% CI 1.001–1.014, p = 0.029), and was also a risk factor for 90-day and 180-day mortality (OR 1.013 95% CI 1.005–1.021, p = 0.002 and OR 1.009 95% CI 1.001–1.018, p = 0.026, respectively). CRP levels ≥35.9 mg/dL could predict death at 30 days with a sensitivity of 0.810 and a specificity of 0.614.ConclusionsThe early mortality after PEG placement is high. CRP, an indicator of acute illness, is a useful parameter at identifying patients with increased probability of dying after PEG insertion. High CRP levels should be considered in the decision making process.