Evaluation of Electrolyte Imbalances and Their Impact on Mortality in Percutaneous Endoscopic Gastrostomy Patients in the Emergency Department

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a nutritional intervention used in patients with impaired oral intake but a functioning gastrointestinal system. PEG is considered the gold standard access route for long-term enteral nutrition. This study aims to evaluate the changes in serum electrolyte levels in patients with PEG presenting to the Emergency Department (ED) and to investigate their association with clinical outcomes, including morbidity and mortality. Methods: In this single-center retrospective cohort study, 87 patients with PEG admitted to the ED between January 1, 2021, and January 1, 2025, were analyzed. Results: The mean age was 70.2 ± 6.8 years, and 36.8% were female. The most common admission reason was tube obstruction/leakage (48.3%). Electrolyte disturbances were detected in 21.8% of patients. The overall mortality rate was 9.2%, with all deceased patients exhibiting electrolyte abnormalities(p<0.001). Hypochloremia, hypophosphatemia, and elevated bicarbonate levels were significantly associated with mortality (p<0.001 for all). Normal calcium and potassium levels correlated with increased survival (p<0.001; p=0.001, respectively). Elevated inflammatory markers (LDH, WBC, CRP) were significantly higher in non-survivors (p<0.05). Logistic regression identified increased bicarbonate level as an independent risk factor for mortality (OR 1.36; 95% CI 1.08–1.72; p=0.01). No significant associations were found between electrolyte levels and morbidity, except higher magnesium and inflammatory markers in patients with neurological or infectious complications. Conclusion: Electrolyte disturbances, particularly hypochloremia, hypophosphatemia, and elevated bicarbonate, are strongly associated with mortality in PEG patients presenting to the ED. Close monitoring and correction of electrolytes may improve outcomes in this vulnerable population

Keywords

• Bicarbonate
• Electrolyte Disturbance
• Emergency Department
• Mortality
• Percutaneous Endoscopic Gastrostomy (PEG)

Acil Serviste Perkütan Endoskopik Gastrostomi Uygulanan Hastalarda Elektrolit Dengesizliklerinin Değerlendirilmesi ve Mortalite Üzerindeki Etkileri

Abstract

Giriş: Perkütan endoskopik gastrostomi (PEG), oral alımı bozulmuş ancak gastrointestinal sistemi işlevsel olan hastalarda uygulanan bir beslenme yöntemidir. PEG, uzun dönem enteral beslenme için altın standart giriş yolu olarak kabul edilmektedir. Bu çalışmanın amacı, PEG taşıyan ve acil servise (AS) başvuran hastalarda serum elektrolit düzeylerindeki değişiklikleri değerlendirmek ve bu değişikliklerin morbidite ve mortalite gibi klinik sonuçlarla olan ilişkisini araştırmaktır. Yöntemler: Bu tek merkezli, retrospektif kohort çalışmasında, 1 Ocak 2021 ile 1 Ocak 2025 tarihleri arasında AS’ye başvuran PEG'li 87 hasta analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 70,2 ± 6,8 yıl olup, %36,8’i kadındı. En sık başvuru nedeni PEG tüpü tıkanıklığı/sızıntısıydı (%48,3). Hastaların %21,8’inde elektrolit bozuklukları tespit edildi. Genel mortalite oranı %9,2 olup, hayatını kaybeden tüm hastalarda elektrolit bozukluğu mevcuttu (p<0,001). Hipokloremi, hipofosfatemi ve yüksek bikarbonat düzeyleri mortalite ile anlamlı düzeyde ilişkiliydi (tümünde p<0,001). Normal kalsiyum ve potasyum düzeyleri, sağkalım ile pozitif yönde ilişkiliydi (sırasıyla p<0,001 ve p=0,001). Artmış inflamatuar belirteçler (LDH, lökosit, CRP, CRP/albumin oranı) yaşamını yitiren hastalarda anlamlı olarak daha yüksekti (p<0,05). Lojistik regresyon analizinde artmış bikarbonat düzeyi, mortalite için bağımsız risk faktörü olarak saptandı (OR: 1,36; %95 GA: 1,08–1,72; p=0,01). Elektrolit düzeyleri ile morbidite arasında anlamlı ilişki bulunmazken, nörolojik veya enfeksiyöz komplikasyonları olan hastalarda magnezyum düzeyleri ve inflamatuar belirteçlerin daha yüksek olduğu görüldü. Sonuç: Acil servise başvuran PEG hastalarında görülen elektrolit bozuklukları, özellikle hipokloremi, hipofosfatemi ve yüksek bikarbonat düzeyleri, mortalite ile güçlü şekilde ilişkilidir. Bu kırılgan hasta grubunda elektrolitlerin yakından izlenmesi ve zamanında düzeltilmesi, klinik sonuçları iyileştirebilir.

Keywords

• Bikarbonat
• Elektrolit Bozukluğu
• Acil Servis
• Mortalite
• Perkütan Endoskopik Gastrostomi (PEG).

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