Gastrostomy Tube Placement for Enteral Nutrition Among Hospitalized Patients With Cirrhosis Is Associated With Increased Mortality.

OBJECTIVE

Gastrostomy tubes may be associated with increased morbidity and mortality in patients with cirrhosis. However, as liver transplantation becomes more accessible, clarifying the feasibility of using these devices to overcome malnutrition and sarcopenia is increasingly relevant. We aim (1) to show whether gastrostomy tube placement increases mortality in patients with cirrhosis and (2) to examine which additional factors influence the odds for procedure-related complications and death.

METHODS

The National Inpatient Sample was queried from 2016 to 2019 for patients with cirrhosis. After collecting relevant demographic and clinical data, we used propensity score matching to address selection biases that may have impacted the decision to pursue gastrostomy tube placement. Finally, we performed logistic regression analyses for key outcome measures, including mortality and procedure-related complications.

RESULTS

The unweighted sample included 593,108 admissions, of which gastrostomy tube placement occurred in 5062. In our matched cohort, death occurred in 22% of those who received a gastrostomy tube versus 9% of those who did not. Gastrostomy tube placement was the strongest predictor of in-hospital mortality (adjusted odds ratio 2.74, 95% CI: 2.44-3.08; P<0.001). Our secondary analyses demonstrated that ascites increased the odds of both procedure-related complications and death, although other factors were also implicated.

CONCLUSION

Gastrostomy tube placement is independently associated with increased mortality in patients with cirrhosis, and those with decompensated disease, namely ascites, and additional medical comorbidities are more likely to develop adverse events. These findings highlight the need for individualized approaches in managing malnutrition in patients with cirrhosis.