title: Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life.
  
  
  OBJECTIVE
  To evaluate risk factors for early and delayed mortality after gastrostomy placement.
  
  
  METHODS
  A single-center retrospective analysis of a prospectively-collected database including all patients undergoing gastrostomy placement for enteral nutrition was performed. Two operators performed all the procedures according to the most recent guidelines.
  
  
  RESULTS
  Analysis included data on 438 patients [178 male; 80.5 (72-86) year-old]. Indications for PEG were stroke (34.0%), dementia (31.3%), neurodegenerative disorders (18.5%), coma (9.1%) and cancer (7.1%). No periprocedural adverse events was observed. Mean survival was 14.6±3.4months; 1-month and 3-month mortality rates were 4.0% and 8.1%, respectively. Severe hypernatremia (≥150mmol/L) was independently related to 1-month mortality (odds ratio 25.4; P<0.0001), while C-reactive protein level>4.3mg/dL was independently related to 3-month mortality (odds ratio 5.3; P=0.003). Kaplan-Meier and Cox-regression analysis identified male gender (hazard ratio 2.32; P=0.0002), severe hypernatremia (hazard ratio 4.3; P<0.0001), C-reactive protein>4.3mg/dL (hazard ratio 3.5; P=0.0014), leukocytosis (hazard ratio 1.97; P=0.0036) and presence of underlying malignancy (hazard ratio 2.4; P=0.0013) as independent risk factors for long-term mortality.
  
  
  CONCLUSIONS
  Presence of severe hypernatremia and increased C-reactive protein levels were strongly correlated with early and delayed mortality in our population. Studies are necessary to understand whether correcting underlying dehydration and inflammation further improves patients' outcomes.
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Muratori
authors.affiliation: Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy. Electronic address: lisotti.andrea@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.affiliation: Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fusaroli
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Caponi
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gibiino
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Leonardo Henry
authors.initials: LH
authors.lastname: Eusebi
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brighi
authors.affiliation: Anesthesiologist Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Altimari
authors.affiliation: S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D003704:Dementia / Q000150:complications / Q000401:mortality*; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology*; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D019636:Neurodegenerative Diseases / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality*
chemical_list: D002097:C-Reactive Protein
keywords: Cancer; Dementia; Dysphagia; Palliative care; Survival; Swallowing disorders