ArticleTurkish journal of surgery2026
Pre-procedural predictors of in-hospital mortality in ICU patients undergoing endoscopic PEG placement.
Article in Turkish journal of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in patients unable to maintain oral intake. However, PEG placement is already considered a high-risk intervention in the intensive care unit (ICU), where short-term mortality is substantial. This study aimed to identify predictors of in-hospital mortality in ICU patients undergoing PEG. Material and Methods: A retrospective cohort study was conducted at a single tertiary center from 2019 to 2024, including all consecutive adult ICU patients who underwent endoscopic PEG. Demographic, clinical, laboratory, and procedural data were analyzed. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used to identify independent predictors. Results: A total of 364 ICU patients underwent PEG, of whom 125 (34.3%) died during the index hospitalization. Among non-survivors, 56 (44.8%) died within the first 14 days after PEG placement. Non-survivors showed lower albumin levels (24.4 vs. 28.2 g/L; p<0.001), higher urea concentrations (57.1 vs. 40.6 mg/dL; p<0.001), higher neutrophil-lymphocyte ratio (6.44 vs. 4.81; p=0.002), and more frequent infection at the time of PEG (88% vs. 58.6%; p<0.001). Prolonged mechanical ventilation (>14 days) was more common among non-survivors (23.2% vs. 11.7%; p=0.005). In the multivariate model, active infection [odds ratio (OR) 3.62; p<0.001], lower albumin (OR 0.90 per g/L; p<0.001), and higher urea (OR 1.02; p=0.05) independently predicted in-hospital mortality, whereas prolonged intubation showed a strong trend but did not reach significance (OR 1.85; p=0.06). Conclusion: ICU patients with active infection, severe hypoalbuminemia, and elevated urea levels have a markedly increased risk of in-hospital mortality after PEG placement. Prolonged mechanical ventilation appears to characterize a clinically more fragile ICU population rather than serving as an independent predictor of mortality. Incorporating these objective markers into pre-procedural assessments may improve patient selection and support decision-making in the ICU.
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