Pre-procedural predictors of in-hospital mortality in ICU patients undergoing endoscopic PEG placement

Objective: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in patients unable to maintain oral intake. However, PEG placement is already considered a high-risk intervention in the intensive care unit (ICU), where short-term mortality is substantial. This study aimed to identify predictors of in-hospital mortality in ICU patients undergoing PEG. Material and Methods: A retrospective cohort study was conducted at a single tertiary center from 2019 to 2024, including all consecutive adult ICU patients who underwent endoscopic PEG. Demographic, clinical, laboratory, and procedural data were analyzed. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used to identify independent predictors. Results: A total of 364 ICU patients underwent PEG, of whom 125 (34.3%) died during the index hospitalization. Among non-survivors, 56 (44.8%) died within the first 14 days after PEG placement. Non-survivors showed lower albumin levels (24.4 vs. 28.2 g/L; p<0.001), higher urea concentrations (57.1 vs. 40.6 mg/dL; p<0.001), higher neutrophil-lymphocyte ratio (6.44 vs. 4.81; p=0.002), and more frequent infection at the time of PEG (88% vs. 58.6%; p<0.001). Prolonged mechanical ventilation (>14 days) was more common among non-survivors (23.2% vs. 11.7%; p=0.005). In the multivariate model, active infection [odds ratio (OR) 3.62; p<0.001], lower albumin (OR 0.90 per g/L; p<0.001), and higher urea (OR 1.02; p=0.05) independently predicted in-hospital mortality, whereas prolonged intubation showed a strong trend but did not reach significance (OR 1.85; p=0.06). Conclusion: ICU patients with active infection, severe hypoalbuminemia, and elevated urea levels have a markedly increased risk of in-hospital mortality after PEG placement. Prolonged mechanical ventilation appears to characterize a clinically more fragile ICU population rather than serving as an independent predictor of mortality. Incorporating these objective markers into pre-procedural assessments may improve patient selection and support decision-making in the ICU.