Hülya TOPÇU, İsmail SEZİKLİ, Duygu TUTAN, Hüseyin KÖSEOĞLU, Ramazan TOPCU

Assessment of factors affecting mortality in patients with percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Amaç:Yoğun bakım ünitesinde kritik hastalara uygulanan perkütan endoskopik gastrostominin(PEG) klinik sonuçları, komplikasyonları ve mortaliteyi etkileyen faktörlerin değerlendirmesi amaçlandı. Gereç ve Yöntem:Ocak 2016-Ocak 2021 tarihleri arasında sadece yoğun bakım ünitesinde PEG takılan 109 hastanın yaşı, cinsiyeti,ek hastalıklar, travma öyküsü, PEG açılmadan önceki serum CRP ve albumin düzeyleri,CRP albumin oranı (CAR),PEG‘e bağlı gelişen komplikasyonlar retrospektif olarak tarandı.Hastalar mortalite görülmeyen (grup 1) ve mortalite görülen(grup 2) olmak üzere 2 gruba ayrılarak değişkenler arasında karşılaştırma yapıldı. Bulgular:Grup 2 olan hastalarınki ise 69,57±16,78 yıl olarak bulundu(p<0,001).Grup 1’de nörolojik,diabet ve nefrolojik hastalıklar grup 2’ye göre istatistiki anlamlılık izlendi (p=0,044, p=0,005).Grup 2 CRP değeri 81,63±54,06, albumin 2,29±0,5 idi (p<0,001).Grup 1 hastalarda CAR ortalaması 15,96±16,81 (p<0,001).Mortalite ayrımı için en uygun CAR cut-off değeri 73,5% sensitivite, 78,9% spesifite, 69,2% pozitif prediktif değer,%82,2 negatif prediktif değer ve 76,8% test kesinliği ile 20,216 olarak bulunmuştur( p<0,001) . Sonuç:CAR oranı, düşük albümin ve yüksek CRP seviyeleri erken mortalitenin öngörücüsü olabileceğini düşünmekteyiz.PEG elektif bir işlem olduğundan hastalar alternatif yollarla beslenme desteği sağlanıp uygun koşullar sağlandığında güvenli ve etkili bir yöntem olabileceğini düşünmekteyiz.

Anahtar Kelimeler:

Perkutan endoskopik gastrostomi, komplikasyonlar, CRP/Albumin oranı, mortalite, Percutaneous endoscopic gastrostomy, complications, CRP/Albumin ratio, mortality

Assessment of factors affecting mortality in patients with percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Aim: It was aimed to evaluate the clinical outcomes, complications, and factors affecting mortality of percutaneous endoscopic gastrostomy (PEG) applied to patients in the intensive care unit (ICU).Material and Method: PEG procedures which were performed in the ICU between January 2016 and January 2021 and patients' age, gender, comorbidities, trauma history, serum CRP, albumin levels, CRP albumin ratios (CAR), and PEG-related complications were reviewed. Patients were divided into two groups, patients without mortality (Group 1) and patients with mortality (Group 2), and a comparison between groups was made.Results: Of all patients, 49 (39.2%) patients had mortality. The mean age of the patients in group 2 was 69.57±16.78 years, which was higher than the other group (p<0.001). Nephrological diseases and diabetes were significantly more common in Group 2, whereas neurologic diseases were less common (p=0.005, p=0.005, 0.044, respectively). The median length of stay (LOS) of the patients in Group 1 was 50 days, while the median LOS of the patients in Group 2 was found to be significantly higher, with 81 days (<0.001). The mean CRP of Group 2 was 81.63±54.06, which was higher than the other group, while the mean of albumin was found to be 2.29±0.5 and was lower than Group 1 (p<0.001, p<0.001). The mean CAR of Group 1 was 15.96±16.81, which was significantly lower than that of Group 2 (p<0.001). The optimal CAR cut-off value for mortality discrimination was found to be 20,216 with a sensitivity of 73.5%, a specificity of 78.9%, a positive predictive value of 69.2%, a negative predictive value of 82.2%, and 76.8% test accuracy. A CAR value of ≥ 20.216 increased the odds of death 9.3-fold (OR 10.385, CI 95% 4.481-24.065, p<0.001). Conclusion: We suggest that CAR ratio, low albumin, and high CRP levels could be predictors of early mortality. Considering that PEG is an elective procedure, we believe that it can be a safe and effective procedure when nutritional support is provided by alternative means and appropriate conditions are met.

Keywords:

Percutaneous endoscopic gastrostomy, complications, CRP/Albumin ratio, mortality,

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