Clinical Severity, Nutritional-Inflammatory Indices, and 90-Day Mortality Following Percutaneous Endoscopic Gastrostomy in Intensive Care Patients: A Retrospective Cohort Study

Background and Objectives: Mortality following percutaneous endoscopic gastrostomy (PEG) may reflect illness severity, nutritional impairment, systemic inflammation, and patient selection. The prognostic value of routinely available indices, including the Prognostic Nutritional Index (PNI) and C-reactive protein-to-albumin ratio (CAR), remains uncertain in critically ill patients undergoing PEG. Materials and Methods: This retrospective cohort analyzed 93 adult intensive care patients who underwent PEG, with one index PEG retained per patient. Pre-PEG feeding and swallowing context, functional dependence, clinical-procedure consent documentation, and the availability of decision-relevant fields were described from retrospective hospital records. The primary outcome was date-defined 90-day all-cause mortality, calculated from the calendar-day difference between recorded PEG and death dates, with PEG placement defined as day 0; 30-day mortality was secondary. Separate multivariable logistic models included age, sex, APACHE II, and either PNI or log2-transformed CAR. Results: Date-derived death occurred within 30 days in 25/93 patients (26.9%; 95% CI, 18.9–36.7). Among 92 patients classifiable at 90 days from the available date fields, 45 deaths occurred by day 90 (48.9%; 95% CI, 38.9–59.0), and 47 patients had no recorded death through day 90; one patient with a last-known-alive date at day 81 and no recorded death was not classifiable for the 90-day endpoint. APACHE II was associated with 90-day death in both models (PNI model OR per 5 points, 1.95; 95% CI, 1.17–3.26; p = 0.011; CAR model OR, 1.96; 95% CI, 1.17–3.27; p = 0.011), whereas PNI and CAR were not statistically significantly associated. In the CAR model, age was also associated with 90-day death (OR per 10 years, 1.36; 95% CI, 1.02–1.81; p = 0.039). Primary PEG indications were predominantly acute or chronic neurological dysphagia (73.1%) and prolonged mechanical ventilation or ICU stay (18.3%), with dysphagia due to dementia recorded as the primary indication in only one patient (1.1%, alive at 90 days); all 93 patients had documented swallowing assessments and signed procedure consent after a median of 23 days of nasogastric/nasojejunal feeding. Among the 45 deaths by day 90, recorded causes were sepsis, septic shock, or multiorgan dysfunction in 32 (71.1%), acute respiratory failure in 6 (13.3%), cardiovascular/cardiorenal causes in 4 (8.9%), and cerebrovascular causes in 3 (6.7%), with no recorded deaths directly attributed to the PEG procedure (0/93) and four acute or subacute post-PEG events descriptively noted. Conclusions: In this retrospective intensive care cohort, higher APACHE II scores were associated with date-defined 90-day all-cause mortality. PNI and CAR were not statistically significantly associated with 90-day mortality in separate adjusted models. These findings describe all-cause outcomes following PEG and do not establish mortality attributable to PEG or the appropriateness of individual PEG decisions.