International Journal of Cerebrovascular Disease and Stroke (ISSN: 2688-8734)

research article

Predictors of Mortality Following PEG Insertion in Stroke Patients

Zaidi Syed AH (MRCP, MBA)1, Owojori OO (FRCP, FACP)2, Chu C (MRCP)1, Bonnett LJ (MSc Med Stats)3, Fitzsimmons P (FRCP)1, Sharma N (FRCP)1, Lopez P1 (RGN), Fletcher G1, F. Hussain (FRCP)1, Bangs F1, Naraen A (MRCP)1, Cawley A1, Manoj A (FRCP)1

1Royal Liverpool University Hospital and Broadgreen Hospitals NHS Trust

2United Lincolnshire NHS Trust Hospitals

3University of Liverpool, UK

*Corresponding author: Syed Asher Hussain Zaidi, Royal Liverpool University Hospital and Broadgreen Hospitals NHS Trust, Liverpool, UK

Received Date: 03 November, 2020; Accepted Date: 20 November, 2020; Published Date: 25 November, 2020

Abstract

Background: Dysphagia following Stroke is very common and percutaneous endoscopic gastrostomy (PEG) tube insertion is considered as an option to help stroke patients start feeding. The aim of our study was to investigate if Specific factors could predict mortality risk in post stroke patients who had PEG tube insertion for persistent dysphagia. The FOOD trial has shown that early PEG insertion following a stroke is associated with an increase in absolute risk of death 1.0% (95% CI -10 to 11.9; p = 0.9) and increase risk of death and poor outcome 7.8% (95% CI 0.0 to 15.5; p = 0.05).

Methods: This was a retrospective study of 124 patients who had PEG tube insertion following stroke who were admitted to the stroke unit at the Royal Liverpool Hospital between 2009 to 2013. Univariable Analysis was done from time to death from date of PEG insertion analyzed using Cox’s proportional hazards method. Parsimonious multivariable model was built using backwards selection with variables dropped according to Akaike’s Information Criterion.

Results: Median follow-up was 6.8 years (IQR 6.0 to 7.4 years). Median event-free survival was 1.4 years (IQR: 0.7 to 1.9 years). Co-variables included age, stroke sub-type, Charlson Co-Morbidity Index (CCI), serum albumin and BMI. Survival time was strongly correlated to: increase in age, Total anterior circulation stroke (TACS), raised CCI, low serum albumin and BMI. Age was significantly associated with time to death – risk of death was 4% higher per year increase in age. Type of stroke was significantly associated with time to death – people with TACS were 65% more likely to die than those with haemorrhagic stroke. Charlson Co-Morbidity Index was significantly associated with time to death – risk of death was 15% higher per unit increase in Charlson Co-Morbidity Index.Serum albumin was significantly associated with time to death – risk of death was 5% lower per unit increase in serum albumin. BMI was significantly associated with time to death – risk of death was 5% lower per unit increase in BMI.

Conclusion: This study demonstrates a clear prognostic value of these co-variables with patients worked up for PEG insertion after stroke. Interesting find was that a combination of TACS stroke, Age >80, Albumin <30g/L, CCI >=9 and low BMI in Men had probability of upto >80 % 6 month mortality after PEG insertion. We propose that Further Multicenter research is required to determine a predictive algorithm to be used in future guidelines and management of PEG-based decisions in stroke.

Keywords

Ischemic Stroke; Percutaneous Enterogastrostomy (PEG); Dysphagia and mortality


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