Percutaneous Endoscopic Gastrostomy (PEG) means that you are operating a silicone tube for gastric feeding directly through the abdominal wall into the stomach. The method is used primarily on patients who for a long time have been unable to swallow and eat in the usual way to get nutrients, for example cancer of the throat or oesophagus or after a stroke. In Sweden, there are several thousands of PEG operations per year. One problem with surgery is that the risk of infection and other complications are high, which at worst can lead to death.
Albumin is the most abundant protein in the blood and is especially important to keep the blood fluid in the blood vessels. It is also associated with malnutrition and inflammation. CRP is a part of the immune system, and increase significantly in the concentration of bacterial infections and other inflammatory conditions. The researchers behind the current study say that their results suggest that healthcare providers should consider waiting before adding PEG at low albumin levels combined with high CRP.
The study included 484 patients at the Karolinska University Hospital in Stockholm County during the years 2005 to 2009. It shows that of the 167 patients who had the combination of low albumin and high CRP more than 20 percent died (34 patients) within 30 days. The mortality rate for the patients who had no such risk indicators was less than 3 percent. This corresponds to an increased risk of more than seven times, after taking into account possible confounding factors such as age, sex and underlying diseases such as diabetes, cardiovascular diseases including stroke and neurological diseases. 58 of the patients who participated in the study died.
“It may be worth trying to treat high CRP and provide the patient with nutrition with alternative methods, and then come back for PEG insertion if the infection has subsided and the patient feels better”, says John Blomberg, surgeon and one of the researchers behind the study.”In addition, the treating physician should inform the patient, relatives and remittent about the risks of PEG insertion, especially when the markers for premature death are so strong.”
Karolinska Institutet is one of the world’s leading medical universities. Its mission is to contribute to the improvement of human health through research and education. Karolinska Institutet accounts for over 40 per cent of the medical academic research conducted in Sweden, and offers the country’s broadest range of education in medicine and health sciences. Since 1901 the Nobel Assembly at Karolinska Institutet has selected the Nobel laureates in Physiology or Medicine.
Publication: ‘Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy (PEG) in a prospective cohort study’, Blomberg J, Lagergren P, Martin L, Mattsson F och Lagergren J, Gastrointestinal Endoscopy, online early publication 12 November 2010, doi:10.1016/j.gie.2010.09.012.