Dementia and Cognitive Impairment Are Not Associated With Earlier Mortality After Percutaneous Endoscopic Gastrostomy
Dementia and Cognitive Impairment Are Not Associated With Earlier Mortality After Percutaneous Endoscopic Gastrostomy
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DOI：
10.1177/0148607108321709
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发表时间：
2009-01-01
影响因子：
3.4
通讯作者：
DeLegge, Mark H.
中科院分区：
文献类型：
--
作者：
Gaines, David Isaac;Durkalski, Valerje;DeLegge, Mark H.
背景：关于经皮内镜胃造口术（PEG）后死亡率的危险因素，研究显示了不同的结果。目的：比较行PEG的痴呆或神经损伤所致严重认知障碍（SCI）患者与未行这两种诊断的患者的死亡时间，并研究PEG后30天死亡率的危险因素。方法：对2年以上行PEG的患者进行鉴定。回顾当地医疗记录和社会安全死亡指数，以确定患者的年龄、性别、血清白蛋白、诊断、是否存在痴呆或脊髓损伤、是否存在与PEG相关的并发症以及PEG后的生存时间。根据PEG时的医学诊断计算Charlson共病指数（CCI）。结果：共鉴定出190例患者。45人被诊断为痴呆和/或脊髓损伤，145人没有。痴呆或脊髓损伤患者的中位生存期为53天，而没有这些诊断的患者为78天（P = 0.85）。年龄（比值比[OR] 1.1, 95%可信区间[CI] 1.04-1.12）和白蛋白（OR 0.43, 95% CI 0.22-0.84）与30天死亡率相关，而性别（OR 1.2, 95% CI 4.47-2.90）、CCI （OE 1.1, 95% CI 0.86-1.32）和peg相关并发症的存在（OR 1.6, 95% CI 0.36-6.76）与30天死亡率无关。结论：年龄和血清白蛋白是PEG术后30天死亡率的危险因素。与认知功能完整的患者相比，痴呆或SCI患者在PEG后的生存期并不明显缩短。（中华儿科杂志。2009;33:62-66）
Background: Studies have shown varying results with regard to risk factors for mortality after percutaneous endoscopic gastrostomy (PEG). Objectives: To examine the time to death in patients with dementia or significant cognitive impairment (SCI) due to neurologic injury who had undergone PEG compared with patients without either of these diagnoses, and to examine risk factors for 30-day mortality after PEG. Methods: Patients who had undergone PEG over a 2-year period were identified. Local medical records and the Social Security Death Index were reviewed to ascertain the patients' age gender, serum albumin, diagnoses, presence or absence of dementia or SCI, presence or absence of complications related to PEG, and length of survival after PEG. The Charlson Comobidity Index (CCI) was calculated based on the medical diagnoses at the time of PEG. Results: One hundred ninety patients were identified. Forty-five carried a diagnosis of dementia and/or SCI compared with 145 who did not. Median survival of patients with dementia or SCI was 53 days compared with 78 days in patients without these diagnoses (P = .85). Age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.04-1.12) and albumin (OR 0.43, 95% CI 0.22-0.84) were associated with 30-day mortality, whereas gender (OR 1.2, 95% CI 4.47-2.90), CCI (OE 1.1, 95% CI 0.86-1.32), and presence of PEG-related complications (OR 1.6 95% CI 0.36-6.76) were not . Conclusions: Age and serum albumin are risk factors for 30-day mortality after PEG. Patients with dementia or SCI do not have a significantly shorter survival after PEG than patients with intact cognitive function. (JPEN J Parenter Enteral Nutr. 2009;33:62-66)