title: Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) is a procedure with many complications that sometimes can be devastating. To give better advice to patients referred for PEG regarding risk of complications, important risk factors should be known.
  
  
  OBJECTIVE
  To evaluate whether age, body mass index, albumin levels, C-reactive protein (CRP) levels, indication for PEG, and comorbidity influence the risk of mortality or peristomal infection after PEG insertion.
  
  
  METHODS
  Prospective cohort study from 2005 to 2009. Follow-up 14 days after PEG.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  This study involved 484 patients referred for PEG.
  
  
  METHODS
  PEG.
  
  
  METHODS
  Mortality within 30 days and peristomal infection within 14 days after PEG insertion. All risk estimates were calculated with 95% CIs and adjusted for confounding.
  
  
  RESULTS
  Among 484 patients, 58 (12%) died within 30 days after PEG insertion. Albumin <30 g/L (hazard ratio [HR], 3.46; 95% CI, 1.75-6.88), CRP ≥10 (HR, 3.47; 95% CI, 1.68-7.18), age ≥65 years (HR, 2.26; 95% CI, 1.20-4.25) and possibly body mass index <18.5 (HR, 2.04; 95% CI, 0.97-4.31) were associated with increased mortality. Patients with a combination of low albumin and high CRP levels had a mortality rate of 20.5% compared with 2.6% among patients with normal values, rendering an over 7-fold increased adjusted risk of mortality (HR, 7.45; 95% CI, 2.62-21.19).
  
  
  CONCLUSIONS
  Missing data in some study variables. Although the sample size was large, weaker associations could not be established.
  
  
  CONCLUSIONS
  The combination of low albumin and high CRP levels indicates a substantially increased short-term mortality risk after PEG, which should be considered in decision making.
authors.affiliation: Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. john.blomberg@karolinska.se
authors.forename: John
authors.initials: J
authors.lastname: Blomberg
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Lena
authors.initials: L
authors.lastname: Martin
authors.forename: Fredrik
authors.initials: F
authors.lastname: Mattsson
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005774:Gastrostomy / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein