title: Increasing Serum Albumin Level Shortly After Gastrostomy Tube Insertion Predicts Longer Survival in Elderly Patients With Dementia.
abstract: OBJECTIVE
  To identify factors influencing survival after percutaneous endoscopic gastrostomy (PEG) tube insertion in elderly patients with severe dementia.
  
  
  BACKGROUND
  Use of PEG in patients with dementia raises medical and ethical questions.
  
  
  METHODS
  The cohort included 189 patients aged ≥64 years with severe dementia who underwent PEG tube insertion in 2002 to 2011 at a tertiary hospital and were followed through 2014. Data were collected on background diseases, laboratory tests conducted 14 (±10) days before and 90 (±10) days after PEG, and date of death. Multivariate Cox regression analysis was performed and cumulative survival curves plotted.
  
  
  RESULTS
  Mean baseline serum albumin level was significantly lower in patients who died ≤30 days after PEG (n=32, 16.9%) than patients who survived longer (2.9±0.5 vs. 3.3±0.5 g/dL, P<0.001), and significantly higher in patients who survived 1 year after PEG (n=96, 50.8%) than patients who died earlier (3.4±0.5 vs. 3.1±0.5 g/dL, P=0.002). No significant differences were found for the other laboratory parameters. After adjustment for background diseases, serum albumin level above the median (3.3 g/dL) was the only predictor of survival (hazard ratio 0.51; 95% confidence interval, 0.37-0.72; P<0.001). Patients with stable/increased serum albumin levels at 90 days after PEG (n=80, 42.3%) survived longer than patients with decreased levels. The only predictor of survival after adjustment for age and background diseases was a stable/increased albumin level at 90 days (hazard ratio 0.59; 95% confidence interval, 0.42-0.85; P=0.004).
  
  
  CONCLUSIONS
  Survival after PEG tube insertion is associated with a higher serum albumin level at baseline and a stable/increased serum albumin level during follow-up.
authors.affiliation: *Gastroenterology Department ‡Geriatric Department, Rabin Medical Center-Beilinson Hospital †Gastroenterology Unit, Petach Tikva ∥Department of Surgery B, Rabin Medical Center-Hasharon Hospital, Petach Tikva, Israel §Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gingold-Belfer
authors.forename: Avraham
authors.initials: A
authors.lastname: Weiss
authors.forename: Alex
authors.initials: A
authors.lastname: Geller
authors.forename: Boris
authors.initials: B
authors.lastname: Sapoznikov
authors.forename: Yichayaou
authors.initials: Y
authors.lastname: Beloosesky
authors.forename: Nira
authors.initials: N
authors.lastname: Morag-Koren
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Doron
authors.initials: D
authors.lastname: Boltin
authors.forename: Nidal
authors.initials: N
authors.lastname: Issa
authors.forename: Hemda
authors.initials: H
authors.lastname: Schmilovitz-Weiss
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D003704:Dementia / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000401:mortality*; D006299:Health Services for the Aged; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012709:Serum Albumin / Q000378:metabolism*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D012709:Serum Albumin