İbrahim Eryilmaz, Özge Tuncer
In this retrospective cohort, markers of metabolic depletion and systemic inflammation, particularly hypoalbuminemia, elevated CRP/NLR, and low serum creatinine, were independently associated with short- and long-term mortality after PEG insertion. These associations remained clinically relevant after considering procedural indication, although the heterogeneity of PEG candidates and the retrospective nature of the study preclude causal inference. Low serum creatinine may reflect a high-risk phenotype characterized by reduced muscle reserve, but it should be interpreted as an indirect surrogate rather than a diagnostic marker of sarcopenia. Incorporating routinely available pre-procedural markers such as albumin, CRP, NLR, and creatinine into the clinical assessment may support more individualized PEG candidate evaluation and shared decision-making.
BACKGROUND & AIMS: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition; however, mortality remains substantial, particularly among frail and multimorbid patients. Data on how specific metabolic and inflammatory phenotypes influence both early and long-term survival after PEG are limited. This study aimed to identify predictors of 30-day and long-term mortality following PEG, with a particular focus on nutritional and inflammatory biomarkers.
METHODS: This single-center retrospective cohort study included 495 adult patients who underwent PEG insertion between December 2013 and May 2024. Predictors of 30-day mortality were assessed using multivariable logistic regression. Long-term survival, with follow-up of up to 10 years, was evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards regression.
RESULTS: The mean age of the cohort was 72.5 ± 15.5 years, and 30-day all-cause mortality occurred in 97 patients (19.6%). In multivariable logistic regression analysis, low serum creatinine (<0.40 mg/dL; OR=2.64), elevated neutrophil-to-lymphocyte ratio (NLR > 5; OR=2.31), hypoalbuminemia, and a higher Age-Adjusted Charlson Comorbidity Index were independently associated with early mortality. Long-term survival analysis demonstrated a pronounced gradient according to metabolic status. Patients with severe hypoalbuminemia (<2.0 g/dL) had a median survival of only 40 days, compared with 776 days in the highest albumin category (≥3.2 g/dL) (p < 0.001). Marked systemic inflammation (CRP > 150 mg/L) was associated with a median survival of 46 days. Notably, very low serum creatinine (<0.40 mg/dL), interpreted as an indirect marker of reduced creatinine generation and potentially reduced muscle reserve, was independently associated with long-term mortality (HR= 1.77, 95% CI 1.15-2.71) and in contrast, elevated creatinine was not independently associated with mortality in the adjusted model.
CONCLUSION: In this retrospective cohort, markers of metabolic depletion and systemic inflammation, particularly hypoalbuminemia, elevated CRP/NLR, and low serum creatinine, were independently associated with short- and long-term mortality after PEG insertion. These associations remained clinically relevant after considering procedural indication, although the heterogeneity of PEG candidates and the retrospective nature of the study preclude causal inference. Low serum creatinine may reflect a high-risk phenotype characterized by reduced muscle reserve, but it should be interpreted as an indirect surrogate rather than a diagnostic marker of sarcopenia. Incorporating routinely available pre-procedural markers such as albumin, CRP, NLR, and creatinine into the clinical assessment may support more individualized PEG candidate evaluation and shared decision-making.