Risk Factors for Mortality Following Percutaneous Endoscopic Gastrostomy in Tunisian ICU Patients

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Aims The Percutaneous Endoscopic Gastrostomy (PEG) procedure is the preferred feeding route for ICU patients who require prolonged nutritional support. Yet, this procedure carries a substantial mortality risk, particularly in critical care environments. In Tunisia, where ICU resources and patient demographics may differ from other regions, understanding the factors that influence post-gastrostomy survival is crucial. This study explores the mortality rates among Tunisian ICU patients in the 30 days following PEG, aiming to uncover key risk factors that may enhance clinical decision-making and improve patient outcomes in intensive care settings. Methods This retrospective study included all patients admitted to the ICU at Sahloul Hospital, Sousse, who underwent endoscopic gastrostomy between June 2022 and June 2024. Demographic, clinical, and biological data were collected from the hospital database. Patients were followed for 30 days post-procedure to assess mortality outcomes. Risk factors associated with 30-day mortality were identified using univariate and multivariate analyses. Results Our study included 61 patients, with a mean age of 51.6±16.3 years and a male-to-female ratio of 1.95. Univariate analysis revealed that smoking (p=0.037), mechanical ventilation (p=0.013), pressure ulcers (p=0.002), infections of all etiologies (p<0.001), and albumin levels<25 g/L (p<0.001) were significantly associated with 30-day mortality. In contrast, sex, age, and the etiological factor were not significantly associated with mortality. ROC curve analysis also revealed that the following factors were significantly associated with 30-day mortality: neutrophil levels>7100/mm³ (AUC=0.682; p=0.015), lymphocyte levels<950/mm³ (AUC=0.670; p=0.023), neutrophil/lymphocyte ratio (NLR)>10.1 (AUC=0.721; p=0.003), CRP levels>33 mg/L (AUC=0.751; p=0.001), procalcitonin levels>0.34 (AUC=0.813; p<0.001), and ICU hospitalization period before PEG>13 days (AUC=0.721; p=0.003). Multivariate analysis showed that only albumin levels<25 g/L (OR=16.6; 95% CI=[2.4; 64.6]; p=0.003), procalcitonin levels>0.34 (OR=12.5; 95% CI=[2.6; 107.5]; p=0.003), and ICU hospitalization period before PEG>13 days (OR=8.3; 95% CI=[1.5; 47.9]; p=0.017) were independently associated with a higher risk of mortality within 30 days following PEG insertion. Conclusions These findings highlight the importance of early identification and management of critically ill patients at high risk for poor outcomes following PEG. Clinicians should consider these factors when making decisions about nutritional support interventions. Further studies are needed to refine risk stratification models for improving patient outcomes in ICU settings. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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