Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi 329-2763, Japan.
World J Gastroenterol. 2010 Oct 28;16(40):5084-91. doi: 10.3748/wjg.v16.i40.5084.
To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan.
We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient's characteristics at PEG using log-rank tests and Cox proportional hazard models.
Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors.
These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.
研究经皮内镜胃造口术（PEG）治疗的老年患者的长期生存情况。
我们回顾性纳入了日本的 46 家社区和三级医院，调查了 2005 年 1 月 1 日至 2008 年 12 月 31 日期间因吞咽困难新行 PEG 的 931 例≥65 岁的老年患者。我们将死亡作为结局，使用对数秩检验和 Cox 比例风险模型探索 PEG 时患者特征之间的关联。
931 例患者中位随访 468d。共观察到 502 例死亡（死亡率 53%）。然而，931 例患者中分别有 99%、95%、88%、75%和 66%的患者存活时间超过 7、30、60d、半年和 1 年。此外，分别有 50%和 25%的患者存活时间超过 753 和 1647d。8 例死亡被认为与 PEG 相关，与较低的血清白蛋白水平相关（P=0.002）。另一方面，在 28 例存活患者（6.5%）中，PEG 被移除。在多变量风险模型中，年龄较大（风险比[HR]，1.02；95%置信区间[CI]，1.00-1.03；P=0.009）、C 反应蛋白较高（HR，1.04；95%CI：1.01-1.07；P=0.005）和血尿素氮较高（HR，1.01；95%CI：1.00-1.02；P=0.003）是预后不良的显著因素，而白蛋白较高（HR，0.67；95%CI：0.52-0.85；P=0.001）、女性（HR，0.60；95%CI：0.48-0.75；P<0.001）和无既往缺血性心脏病史（HR，0.69；95%CI：0.54-0.88，P=0.003）是明显的预后良好因素。
这些结果表明，PEG 治疗的老年患者中有一半以上可能存活 2 年以上。分析结果阐明了预后因素。
