PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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Submitted Abstracts

PENSA 2017 Congress

Submitted: October 6, 2017

Abstract ID = 83 | Classification: (5) - Enteral nutrition

Title: Comparing preoperative TLC and %TLC as nutritional risk factors predicting mortality after percutaneous endoscopic gastrostomy (PEG)

Author(s): Haruna Nakamura, Wong Toh Yoon, Kaori Yoneda, Yukiko Endo, Kayoko Nakao, Chie Mihara

Institution where study was conducted: Hiroshima Kyoritsu Hospital

Keywords: percutaneous endoscopic gastrostomy (PEG), TLC

Background: Percutaneous Endoscopic Gastrostomy (PEG) is the preferred route for long term enteral nutrition in dysphagic patients. However, the 30-day mortality rate after PEG is reported to be between 5.9% and 10.6% in Japan. The Total Lymphocyte Count (TLC) is a commonly used nutritional indicator and also needed to calculate the Onodera-Prognostic Nutrition Index (O-PNI).

Objectives: We examined whether it might be more accurate to use the percentage of lymphocyte to total white blood cell count (%TLC) as a nutritional prognostic indicator by comparing TLC and %TLC as prognostic factors for PEG.

Methods: 190 patients (88 men and 102 women) who received PEG for enteral nutrition at our hospital between September 2013 and September 2016 were analyzed using ROC analysis to compare TLC and %TLC as predictors for postoperative mortality.

Results: Mean age of patients was 81.4±8.6 (SD) years old. 133 patients (75.3%) had cerebrovascular disease. Average postoperative length of stay was 21.5±20.7 days. 19 patients (10%) died before discharge, with 12 of them (6.5%) within 30 days after PEG. Nutrition biomarkers: Body mass index (BMI) 18.5±9.2 kg/m2, Serum albumin (Alb) 2.8±0.5 g/dl, TLC 1498±744/μL, %TLC 22.3±9.8%, O-PNI 35.7±6.8, Geriatric Nutritional Risk Index (GNRI) 76.7±18.6. AUC (Area under the curve) for the outcome of in-hospital mortality after PEG: BMI 0.63 (95%CI: 0.48-0.77), Alb 0.64 (95%CI: 0.53-0.76), TLC 0.65 (95%CI: 0.53-0.78), %TLC 0.70 (95%CI: 0.60-0.81), O-PNI 0.68 (95%CI: 0.58-0.79), GNRI 0.68 (95%CI: 0.56-0.80)

Conclusion: Preoperative %TLC is a superior prognostic factor than TLC or nutritional risk indices such as O-PNI and GNRI when it comes to predicting in-hospital mortality after PEG. It may be useful to employ %TLC during preoperative nutritional assessment of patients undergoing PEG.