Mantri Nikhitha, Sun Haozhe, Kandhi Sameer Datta, Allena Nishant, Anwar Muhammad Yasir, Hayagreev Vibha, Penikilapate Shalini, Alemam Ahmed, Muntazir Hassan A, Acherjee Trishna, Patel Harish, Makker Jasbir
Division of Gastroenterology, Department of Medicine, BronxCare Health System, Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, 10C, 1650 Selwyn Avenue, Bronx, NY, 10457, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, BronxCare Health System, Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY, 10457, USA.
BMC Gastroenterol. 2024 Dec 31;24(1):482. doi: 10.1186/s12876-024-03574-4.
Percutaneous Endoscopic Gastrostomy (PEG) tube insertion, a routine procedure for long-term enteral nutrition, serves as a crucial intervention for patients who are incapable of tolerating oral intake or meeting adequate nutritional requirements. PEG tube placement carries complications like bleeding and infection. Impact of PEG tubes on the 30-day and long-term mortality in HIV patients is unknown. Despite the ongoing utilization of PEG tubes in HIV patients, a comprehensive exploration of its outcomes is yet to be explored. We intended to study the impact of HIV positive status on post-PEG mortality and review other PEG tube related complications.
Our study comprised a total of 639 PEG tubes placed on 461 unique patients, from which 85 patients (n = 18%) were HIV positive. We reviewed all these PEG tube patients at our institution and compared their complications and mortality outcome between the two groups of HIV positive as against HIV negative.
Our findings reveal a statistically significant increase (p-value 0.001) in post-PEG insertion site bleeding in the HIV group (15.3%) compared to the non-HIV group (4.5%). This difference occurred despite no notable variations in laboratory parameters such as platelet count and (international normalized ratio), as well as similar usage of anticoagulant or antiplatelet medications between the two groups. Notably, the 1-year mortality rate in the HIV group stands at 37.6% (p < 0.001), contrasting sharply with the non-HIV group's rate of 17.8%.
This study underscores the need for heightened vigilance and tailored management strategies when considering PEG tube procedures in the context of HIV, given the observed elevated bleeding risks and increased 1-year mortality rates in this patient population. Further research is warranted to elucidate the underlying factors contributing to these outcomes, facilitating the development of targeted interventions to optimize the care of HIV patients undergoing PEG placement.
经皮内镜下胃造口术（PEG）置管是长期肠内营养的常规操作，对于无法耐受经口摄入或无法满足足够营养需求的患者而言是一项关键干预措施。PEG置管会引发出血和感染等并发症。PEG管对HIV患者30天及长期死亡率的影响尚不清楚。尽管PEG管仍在HIV患者中持续使用，但对其结果的全面探索仍有待开展。我们旨在研究HIV阳性状态对PEG术后死亡率的影响，并回顾其他与PEG管相关的并发症。
我们的研究共纳入了461例独特患者所置入的639根PEG管，其中85例患者（n = 18%）为HIV阳性。我们对本机构所有这些PEG管患者进行了回顾，并比较了HIV阳性组和HIV阴性组之间的并发症及死亡率结果。
我们的研究结果显示，与非HIV组（4.5%）相比，HIV组PEG术后置管部位出血发生率有统计学意义的显著增加（p值为0.001）（15.3%）。尽管两组之间血小板计数和国际标准化比值等实验室参数没有显著差异，且抗凝或抗血小板药物的使用情况相似，但仍出现了这种差异。值得注意的是，HIV组一年死亡率为37.6%（p < 0.001），与非HIV组的17.8%形成鲜明对比。
鉴于观察到该患者群体出血风险升高且一年死亡率增加，本研究强调在HIV背景下考虑PEG管操作时需要提高警惕并制定针对性的管理策略。有必要进一步研究以阐明导致这些结果的潜在因素，从而促进开发有针对性的干预措施，以优化接受PEG置管的HIV患者护理。
