Cortés-Flores Ana Olivia, Álvarez-Villaseñor Andrea del Socorro, Fuentes-Orozco Clotilde, Ramírez-Campos Kenia Militzi, Ramírez-Arce Anais del Roció, Macías-Amezcua Michel Dassaejv, Chávez-Tostado Mariana, Hernández-Machuca Joel Sealtiel, González-Ojeda Alejandro
Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico.
Geriatr Gerontol Int. 2015 Jan;15(1):19-26. doi: 10.1111/ggi.12215. Epub 2013 Dec 26.
To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG).
The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan-Meier method.
Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26-29.3), CCI (OR 7.04, 95% CI: 2.31-21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71-6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6-1.26).
Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection.
评估接受经皮内镜下胃造口术（PEG）的墨西哥老年患者的长期生存率及预后因素。
本研究是一项回顾性队列分析，纳入了2005年1月至2012年12月期间110例年龄大于70岁、无头颈部恶性肿瘤且接受了PEG的患者。计算人口统计学和临床变量的比值比（OR）及95%置信区间（CI），并采用Kaplan-Meier法确定生存率。
中位年龄和随访时间分别为82.45±6.6岁和688.3±394.6天。术后早期死亡的患者（n = 6）比存活患者年龄更大。非存活者的卡氏功能状态评分和淋巴细胞计数略低，但差异无统计学意义。非存活者的体重指数和血清白蛋白水平较低（分别为P = 0.03和0.01），且查尔森合并症指数（CCI）较高。共有32例（29%）患者在术后后期死亡，平均随访时间为436.2±267.4天。死亡的危险因素包括卡氏功能状态评分（比值比[OR] 9.76，95% CI：3.26 - 29.3）、CCI（OR 7.04，95% CI：2.31 - 21.41）和术后低白蛋白血症（OR 3.45，95% CI：1.71 - 6.67）。随访期间死亡的患者中36.8%发生了胃造口术后肺炎（OR 0.28，95% CI：0.6 - 1.26）。
卡氏功能状态评分、查尔森合并症指数和术后低白蛋白血症是死亡的独立危险因素。可改变的因素与营养支持有关。早期PEG可能有助于预防营养不良和感染。
