Effects of Covid 19 Pandemic on Peg

Effects of Covid 19 Pandemic on Peg | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Covid 19 Pandemic on Peg Duran Deha Çetin, Şehmus Ölmez, Bünyamin Sarıtaş, Mustafa Harı, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8549527/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Percutaneous endoscopic gastrostomy (PEG) is the preferred method for long-term enteral nutritional support in patients unable to maintain adequate oral intake. PEG candidates often present with multiple comorbidities and are at increased risk for complications. Because the procedure requires close patient contact, infection control is critical, especially during pandemics. This study evaluated the impact of the COVID-19 pandemic on PEG procedures and patient outcomes. Methods We retrospectively analyzed patients who underwent PEG at our tertiary gastroenterology center during the two-year periods before and after the onset of the COVID-19 pandemic. Demographic data, laboratory results, complication rates, and mortality were compared between the two groups. Results PEG was performed in 270 patients before the pandemic and 170 during the pandemic. Mean ages were 65.2 and 63.8 years, respectively. Cerebrovascular disease was the most frequent indication in both groups. Median survival significantly decreased during the pandemic (69 vs. 146 days; p = 0.003). While complication rates remained stable, post-pandemic patients had a 1.46-fold higher mortality risk. Conclusions Although PEG-related complications did not increase, overall survival declined significantly during the COVID-19 period, likely reflecting changes in patient profiles and reduced care continuity. The C-reactive protein (CRP)/albumin ratio maintained its prognostic value for mortality. These findings emphasize the need for uninterrupted nutritional support and multidisciplinary management during pandemics. PEG COVID-19 pandemic complications mortality Figures Figure 1 Introduction Enteral nutrition plays a critical role in maintaining metabolic and immune functions in patients with prolonged illness, trauma, neurological disorders, or those requiring mechanical ventilation or recovering from head and neck surgery. Compared with parenteral nutrition, enteral feeding is associated with fewer complications as it stimulates bowel motility, supports digestion and nutrient absorption, preserves intestinal integrity, enhances immune function, and reduces infection risk ( 1 ). According to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines, enteral nutrition should be initiated within 48–72 hours after intensive care unit (ICU) admission in eligible patients. When nutritional support is expected to continue for more than four weeks, percutaneous endoscopic gastrostomy (PEG) is the preferred and safest route for long-term enteral access ( 2 , 3 ). Although PEG is generally considered a safe procedure, complications may occur with an incidence ranging from 5% to 40%. The most common complication is peristomal infection; however, serious and potentially life-threatening events such as bleeding, visceral injury, buried bumper syndrome, ileus, volvulus, enterocutaneous fistula, and aspiration pneumonia have also been reported ( 4 , 5 ). Major complications include hemorrhage, organ perforation, and buried bumper syndrome, whereas minor complications include local infection, pneumoperitoneum, peristomal leakage, tube dislodgement, and herniation at the PEG site ( 6 ). The COVID-19 pandemic has caused profound disruptions in healthcare systems worldwide. The increased need for mechanical ventilation altered patient demographics and clinical management within ICUs ( 7 ). During this period, PEG placement became increasingly important for ensuring adequate enteral nutrition and facilitating the discharge of ventilator-dependent patients ( 8 ). However, concerns arose regarding the risks of aerosol exposure and contact with infectious bodily fluids during endoscopic procedures. Additionally, the widespread use of anticoagulant therapy in COVID-19 management posed technical challenges for PEG placement ( 9 ). There were also differing opinions regarding the optimal timing of elective endoscopic procedures, with some recommending nasogastric feeding until patients achieved clinical stability suitable for discharge ( 10 ). Therefore, this study aimed to evaluate the effects of the COVID-19 pandemic on PEG practice and patient outcomes, with particular emphasis on procedural complications and mortality. Materials and Methods Study Design and Patient Selection Patients who underwent percutaneous endoscopic gastrostomy (PEG) between September 2018 and May 2022 at the Gastroenterology Clinic of Health Sciences University, Adana City Training and Research Hospital, a tertiary referral center, were included in this retrospective study. Ethical approval was obtained from the Scientific Research Ethics Committee of Adana City Training and Research Hospital (Approval No: 1961). All patient data were retrieved through a retrospective review of hospital records and electronic medical files. Patients with incomplete data or those who underwent PEG tube replacement were excluded from the analysis. Data Collection Demographic characteristics, indications for PEG tube placement, comorbidities, requesting clinical departments, pre-procedural laboratory results, PEG-related complications (bleeding, perforation, buried bumper, local infections), and mortality rates were recorded. Additionally, nasopharyngeal and oropharyngeal swab PCR results for SARS-CoV-2 were documented for patients who underwent PEG during the COVID-19 pandemic, both prior to and within the first week after the procedure. The date of March 11, 2020, when the World Health Organization officially declared COVID-19 a pandemic, was used as the reference point to divide patients into two groups: Group 1 : Patients who underwent PEG before the COVID-19 pandemic. Group 2 : Patients who underwent PEG during the COVID-19 pandemic. Procedure Technique If patients were not receiving antibiotics and had no allergy to β-lactam agents, intravenous cefazolin or ceftriaxone prophylaxis was administered 30 minutes before the procedure. PEG placement was performed using the standard pull technique , guided by transillumination and negative aspiration tests. During the COVID-19 period, all PEG procedures were conducted according to recommendations from the hospital’s Infection Control Committee and contemporary guidelines for endoscopic interventions, ensuring strict adherence to personal protective equipment (PPE) use and infection prevention protocols. Outcome Measures Demographic data, PEG placement dates, clinical and laboratory parameters, post-procedural complications, and mortality rates at one month and two years were compared between the two study groups. In Group 2, patients were further classified based on SARS-CoV-2 PCR positivity. Monthly distributions of PEG procedures during the two years following the onset of the pandemic were also analyzed. Causes of death were categorized as PEG-related or unrelated. Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD), minimum, and maximum values, while categorical variables were summarized as numbers and percentages. Differences in continuous variables between two independent groups were analyzed using the Student’s t -test. Survival curves were estimated using the Kaplan–Meier method, and differences between groups were assessed using the log-rank test. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Associations between categorical variables were analyzed using the chi-square test. A p -value of < 0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Results A total of 440 patients who met the inclusion criteria were included in this study. Of these, 270 patients underwent PEG before the COVID-19 pandemic (Group 1) and 170 during the pandemic (Group 2). The mean age was 64.5 years (range: 18–96 years), with 47.5% females (n = 209) and 52.5% males (n = 231) (Table 1 ). When patients were compared according to the timing of PEG placement (pre- vs. post-pandemic), no statistically significant difference was observed in age or sex distribution ( p > 0.05). Analysis of diagnostic distribution revealed a significant correlation only between cerebrovascular events (CVE) and respiratory failure ( p < 0.05). Evaluation of clinical departments requesting PEG showed significant associations with patients followed by neurosurgery ( p = 0.001) and internal medicine ( p = 0.002) clinics. There were no significant differences in ICU admission rates between the two groups. No statistically significant association was found between the frequency or type of PEG-related complications and the 1-month prognosis of the patients. Comparison of laboratory parameters demonstrated significant differences in INR, urea, creatinine, total protein, CRP, procalcitonin, and albumin levels ( p < 0.05), whereas no significant differences were found in other variables (Table 2 ). Survival analysis showed that 331 of 440 patients (75.3%) died during follow-up. The median survival time was 114 days (95% CI: 89–146), with an overall survival probability of 8%. Among patients who underwent PEG before the pandemic, the median survival time was 146 days (95% CI: 107–199) and survival probability 10%, while those who underwent PEG after the pandemic had a median survival of 69 days (95% CI: 51–114) and survival probability 17%. This difference was statistically significant ( p = 0.003) (Fig. 1 ). In total, deaths occurred in 207 of 270 pre-pandemic patients and 124 of 170 post-pandemic patients. The mortality risk was 1.46-fold higher among patients undergoing PEG during the pandemic compared with those before the pandemic (HR: 1.46; 95% CI: 1.16–1.85) (Table 3 ). Finally, evaluation of the CRP/albumin ratio revealed a statistically significant association with mortality ( p = 0.02) (Table 4 ). Table 1 Descriptive analysis of demographic data (n = 440) Mean ± SD min-max Age 64.65 ± 17.95 18–96 Number (n) Percentage (%) Gender Male 231 52.5 Female 209 47.5 Number of patients Pre-Pandemic 270 61.4 Post-Pandemic 170 38.6 Table 2 Difference/Relationship Evaluation According to Pandemic Period Pre-Pandemic (n = 270) Post-Pandemic (n = 170) Properties Mean ± SD Mean ± SD p value Age 65.2 ± 18.1 63.8 ± 17.8 0.45 n(%) n(%) Gender Male 141(52.2) 90(52.9) 0.88 Female 129(47.8) 80(47.1) Diagnosis 0.03 Dementia 68(25.2) 44(25.9) 0.87 SVO 140(51.9) 70(41.2) 0.03 Malignancy 27( 10 ) 24(14.1) 0.19 Trauma 18(6.7) 14(8.2) 0.54 Respiratory Failure 0(0) 5(2.9) 0.005 Other 17(6.3) 13(7.6) 0.58 Admission department ICU 167(61.9) 116(68.2) 0.43 Ward 98(36.3) 51( 30 ) Outpatient 5(1.9) 3(1.8) ICU CCU 43(25.7) 40(34.5) 0.15 Neurology 14(8.4) 10(8.6) Brain Surgery 32(19.2) 25(21.6) Internal Medicine 67(40.1) 30(25.9) Other 11(6.6) 11(9.5) Ward 0.001 Neurology 23( 23 ) 15(28.3) 0.47 Brain Surgery 5( 5 ) 12(22.6) 0.001 Internal Medicine 59(59) 17(32.1) 0.002 Other 13( 13 ) 9( 17 ) 0.51 Complication No 241(89.3) 155(91.2) 0.63 Yes 29(10.7) 15(8.8) Complication Bleeding 3(10.3) 0(0) 0.06 Perforation 1(3.4) 0(0) Burried Bumper 7(24.1) 0(0) Local Infection 15(51.7) 14(93.3) Other 3(10.3) 1(6.7) Prognosis (1st month) Alive 197(73) 116(68.2) 0.29 Death 73( 27 ) 54(31.8) Mean ± SD Mean ± SD WBC 10147.28 ± 515.85 9335.82 ± 344.05 0.17 HB 10.58 ± 1.71 10.38 ± 1.67 0.06 HCT 31.06 ± 4.92 30.14 ± 4.71 0.06 RDW 17.06 ± 11.91 16.18 ± 2.06 0.34 PLT 277.85 ± 91.51 273.04 ± 91.78 0.69 MPV 9.03 ± 3.31 8.66 ± 1.13 0.16 INR 1.16 ± 0.17 1.11 ± 0.13 0.004 Glucose 136.76 ± 49.63 137.85 ± 54.56 0.84 Urea 51.24 ± 31.39 40.49 ± 32.61 0.003 Creatine 0.77 ± 0.32 0.63 ± 0.34 0.03 Protein 44.71 ± 22.41 56.78 ± 14.35 < 0.001 CRP 59.57 ± 38.18 84.41 ± 48.14 < 0.001 NA 138.86 ± 5.35 138.74 ± 5.05 0.81 F 3.99 ± 0.61 3.95 ± 0.55 0.44 T.Bil 1.06 ± 1.01 2.68 ± 2.24 0.17 AST 35.52 ± 14.14 40.45 ± 18.24 0.26 ALT 30.69 ± 25.41 42.2 ± 121.48 0.06 LDH 322.74 ± 146.81 294.31 ± 134.22 0.11 GGT 75.86 ± 31.31 84.21 ± 22.21 0.64 ALP 109.07 ± 87.14 115.11 ± 88.14 0.71 Procalcitonin 1.02 ± 0.81 0.40 ± 0.15 0.04 Albumin 2.68 ± 0.59 2.85 ± 0.53 0.003 Table 3 Death risk in patients who underwent PEG placement after the pandemic Death n(%) Alive n(%) Survival rate Median Survival (95% CI) Hazard Ratio (95% CI) Log Rank p value Period Pre-Pandemic 207(76.67) 63(23.33) 0.10 146(107–199) 1.46(1.14–1.85) 0.003 Post-Pandemic 124(72.94) 46(27.06) 0.17 69(51–114) Total 331(75.23) 109(24.77) 0.09 114(89–146) Table 4 Effect of CRP/Albumin ratio on mortality. Alive (n = 110) Death (n = 228) Properties Mean ± SD Mean ± SD p value CRP/ALB 21.61 ± 15.91 28.36 ± 14.99 0.02 Discussion The COVID-19 pandemic has had profound and unexpected effects on healthcare systems worldwide ( 11 ). Owing to infection risks, shortages of protective equipment, and changes in hospital patient profiles, many endoscopy units experienced delays or suspensions of elective procedures ( 12 ). Endoscopic interventions are classified as high-risk due to the potential for aerosolization and close contact with patients, leading to exposure to infectious respiratory droplets. Therefore, the use of appropriate personal protective equipment (PPE) during such procedures is strongly recommended ( 13 ). Reports indicate that after implementing strict infection control protocols and limiting elective procedures, the risk of COVID-19 transmission during endoscopy markedly decreased ( 14 ). PEG remains the preferred method for providing long-term (> 30 days) enteral nutritional support ( 15 ). Neurological dysphagia is the most frequent indication, with underlying causes including stroke, dementia, amyotrophic lateral sclerosis (ALS), Guillain–Barré syndrome, Parkinson’s disease, cerebral palsy, myasthenia gravis, encephalitis, meningitis, and polymyositis ( 16 ). In our study, the indications were consistent with the pre-pandemic period. However, during the pandemic, the number of patients requiring PEG for respiratory failure increased, likely reflecting a shift in the ICU patient profile associated with the higher need for mechanical ventilation. Conversely, PEG placements for cerebrovascular events declined during the same period. Previous studies have demonstrated that low serum albumin and elevated C-reactive protein (CRP) levels are independent predictors of both short- and long-term mortality in patients undergoing PEG, irrespective of pandemic conditions ( 17 – 19 ). Consistent with these findings, our study identified a significant association between the CRP/albumin ratio and mortality. Laboratory abnormalities such as elevated INR, urea, creatinine, and acute-phase reactants are expected among critically ill and septic patients ( 20 ), and similar laboratory patterns were observed in our cohort, particularly during the pandemic. Although no increase in the incidence of PEG-related complications was detected before or after the pandemic, survival curves differed significantly between the two periods. The observed 1.4-fold increase in mortality risk and shortened survival following the pandemic may be attributed to changes in the clinical characteristics of patients undergoing PEG and to disruptions in post-procedural follow-up and continuity of care. Both sepsis and COVID-19 have been associated with a prothrombotic state, with critically ill ICU patients being particularly predisposed to thrombotic events. Consequently, antiplatelet and anticoagulant therapies were widely used for treatment and prophylaxis during this period ( 21 ). In our study, no treatment-requiring bleeding complications were observed, and the overall incidence of hemorrhagic events did not increase. This suggests that PEG placement can be performed safely in patients receiving anticoagulant or antiplatelet therapy when appropriate precautions are followed. The pandemic also affected the organization and functioning of hospital wards and ICUs. Many inpatient beds were reallocated for patients with COVID-19 pneumonia, often with multiple comorbidities and critical illness. In our cohort, the distribution of ICU admissions did not differ significantly between groups; however, we observed a notable increase in patients from neurosurgery wards and a decline in those from internal medicine units. This may be explained by the continuation of emergency surgical services and the repurposing of chronic care wards as COVID-19 units. Mortality rates following PEG vary depending on the underlying disease and overall patient condition. Previous studies have reported 30-day mortality rates ranging from 3% to 23% ( 15 , 22 , 23 ). Poor renal function, anemia, advanced age, high CRP, and low albumin levels are known predictors of early mortality ( 24 , 25 ). The most common causes of death are malignancy and pneumonia ( 26 ). In our study, median survival was 114 days pre-pandemic and 93 days post-pandemic—values somewhat lower than those reported in the literature ( 27 ). This discrepancy may be due to the advanced age and frailty of our study population, as well as the inclusion of critically ill ICU patients. Furthermore, some PEG placements may have been performed without sufficient consideration of near-term mortality predictors. The prognostic value of PEG feeding in dementia remains controversial. While some studies suggest that PEG does not improve survival and may even be associated with increased mortality in these patients ( 28 – 30 ), it continues to be performed for both medical and social reasons. In our study, the high proportion of dementia patients may have negatively influenced overall survival outcomes. This study has certain limitations, including its retrospective design, limited follow-up period, and incomplete data regarding medication use and clinical findings. Nevertheless, the large sample size and inclusion of a vulnerable, comorbidity-rich patient population enhance its clinical relevance and contribute valuable insights into PEG practice during pandemic conditions. Conclusion Percutaneous endoscopic gastrostomy (PEG) remains an effective and safe method for maintaining long-term enteral nutrition. During the COVID-19 pandemic, no increase in procedure-related complication rates was observed, and infection transmission risk was minimized through strict adherence to protective equipment use and preventive measures. However, the pandemic period was associated with a reduction in overall survival time among PEG recipients. The C-reactive protein (CRP)/albumin ratio, a recognized short-term mortality marker in PEG candidates, retained its prognostic importance and may aid in identifying patients at higher risk. Our findings underscore the importance of ensuring continuity of nutritional care during pandemics or similar large-scale health crises and provide valuable evidence regarding the safety and clinical relevance of PEG under such conditions. Abbreviations PEG Percutaneous Endoscopic Gastrostomy COVID-19 Coronavirus Disease 2019 CRP C-reactive protein IRB Institutional Review Board Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. Ethical approval for this study was obtained from the Scientific Research Ethics Committee of Adana City Training and Research Hospital (Approval No: 1961). Consent for publication Not applicable. Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution DDC conceived and designed the study.ŞÖ and BS collected the data.MH and BK performed the statistical analysis.EE interpreted the data.DDC drafted the manuscript.All authors critically revised the manuscript and approved the final version. Acknowledgement FundingThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Wei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit. J Thorac Dis. 2021;13(8):5277–96. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006;25(2):210–23. Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. 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Times New Roman, 12 pt • Line spacing: 1.5 lines • Alignment: Justified • References: Numbered (Vancouver style) • Figures and Tables: Each on a separate page at the end of the manuscript • Page numbers: Include in the footer before submission. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 03 Feb, 2026 Editor invited by journal 14 Jan, 2026 Submission checks completed at journal 13 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8549527","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587675023,"identity":"646c63fe-cdb4-44a4-a1d6-604d7b80d6b1","order_by":0,"name":"Duran Deha Çetin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDCCAzxgioeBvQFIGVgQrcWAh4HnAIiWIF4LA4NEAohBhBa+470HP/yo+CNjLvn86oYfBRIM/O3dCXi1SJ45lyzZc8aAx3J2TtnNHqDDJM6c3YBXi8GNHANpxjYDHoPbOWk3eIBaDCRyCWi5/8b4N+M/oJabZ9Ju/iFKyw0eM2nGBqCWG+zHbhNli+SZHDPLnmPGPAZncthuyxhI8BD0C9/xM8Y3ftTI2RscP/7s5ps/NnL87b34tSABHgMwSaxyEGB/QIrqUTAKRsEoGEEAAD0FR5SUJRsxAAAAAElFTkSuQmCC","orcid":"","institution":"University of Health Sciences , Adana City Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Duran","middleName":"Deha","lastName":"Çetin","suffix":""},{"id":587675024,"identity":"1a8b4d3c-b193-4d3c-a484-e7b78ebf310f","order_by":1,"name":"Şehmus Ölmez","email":"","orcid":"","institution":"University of Health Sciences , Adana City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Şehmus","middleName":"","lastName":"Ölmez","suffix":""},{"id":587675025,"identity":"98e0a96c-24c9-44f1-84b3-993d024c5d1b","order_by":2,"name":"Bünyamin Sarıtaş","email":"","orcid":"","institution":"University of Health Sciences , Adana City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bünyamin","middleName":"","lastName":"Sarıtaş","suffix":""},{"id":587675026,"identity":"7e2f1264-c6d5-4812-bdb7-25cfc3636ad2","order_by":3,"name":"Mustafa Harı","email":"","orcid":"","institution":"University of Health Sciences , Adana City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Harı","suffix":""},{"id":587675027,"identity":"8d263428-a633-4411-9ba5-5d31cf30159d","order_by":4,"name":"Banu Kara","email":"","orcid":"","institution":"University of Health Sciences , Adana City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Banu","middleName":"","lastName":"Kara","suffix":""},{"id":587675028,"identity":"ea5933d8-aa86-454e-a874-1fb2a3131e54","order_by":5,"name":"Elif Ertaş","email":"","orcid":"","institution":"Selçuk University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"","lastName":"Ertaş","suffix":""}],"badges":[],"createdAt":"2026-01-08 09:24:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8549527/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8549527/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102238456,"identity":"8bbb75f5-85a4-46b4-abef-a18dc1051a2d","added_by":"auto","created_at":"2026-02-09 16:40:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136884,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival percentage analysis of patients who underwent PEG by the time of application\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8549527/v1/6245a4a9cc37934813dde904.png"},{"id":102238510,"identity":"6810c9b6-45d4-42ae-bda6-cfa2afa530ce","added_by":"auto","created_at":"2026-02-09 16:40:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1000940,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8549527/v1/54e1b190-c553-483d-a8b2-72576ae9f7f6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffects of Covid 19 Pandemic on Peg\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEnteral nutrition plays a critical role in maintaining metabolic and immune functions in patients with prolonged illness, trauma, neurological disorders, or those requiring mechanical ventilation or recovering from head and neck surgery. Compared with parenteral nutrition, enteral feeding is associated with fewer complications as it stimulates bowel motility, supports digestion and nutrient absorption, preserves intestinal integrity, enhances immune function, and reduces infection risk (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e According to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines, enteral nutrition should be initiated within 48\u0026ndash;72 hours after intensive care unit (ICU) admission in eligible patients. When nutritional support is expected to continue for more than four weeks, percutaneous endoscopic gastrostomy (PEG) is the preferred and safest route for long-term enteral access (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough PEG is generally considered a safe procedure, complications may occur with an incidence ranging from 5% to 40%. The most common complication is peristomal infection; however, serious and potentially life-threatening events such as bleeding, visceral injury, buried bumper syndrome, ileus, volvulus, enterocutaneous fistula, and aspiration pneumonia have also been reported (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Major complications include hemorrhage, organ perforation, and buried bumper syndrome, whereas minor complications include local infection, pneumoperitoneum, peristomal leakage, tube dislodgement, and herniation at the PEG site (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has caused profound disruptions in healthcare systems worldwide. The increased need for mechanical ventilation altered patient demographics and clinical management within ICUs (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). During this period, PEG placement became increasingly important for ensuring adequate enteral nutrition and facilitating the discharge of ventilator-dependent patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, concerns arose regarding the risks of aerosol exposure and contact with infectious bodily fluids during endoscopic procedures. Additionally, the widespread use of anticoagulant therapy in COVID-19 management posed technical challenges for PEG placement (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). There were also differing opinions regarding the optimal timing of elective endoscopic procedures, with some recommending nasogastric feeding until patients achieved clinical stability suitable for discharge (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate the effects of the COVID-19 pandemic on PEG practice and patient outcomes, with particular emphasis on procedural complications and mortality.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Selection\u003c/h2\u003e \u003cp\u003ePatients who underwent percutaneous endoscopic gastrostomy (PEG) between September 2018 and May 2022 at the Gastroenterology Clinic of Health Sciences University, Adana City Training and Research Hospital, a tertiary referral center, were included in this retrospective study. Ethical approval was obtained from the Scientific Research Ethics Committee of Adana City Training and Research Hospital (Approval No: 1961).\u003c/p\u003e \u003cp\u003eAll patient data were retrieved through a retrospective review of hospital records and electronic medical files. Patients with incomplete data or those who underwent PEG tube replacement were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e Demographic characteristics, indications for PEG tube placement, comorbidities, requesting clinical departments, pre-procedural laboratory results, PEG-related complications (bleeding, perforation, buried bumper, local infections), and mortality rates were recorded. Additionally, nasopharyngeal and oropharyngeal swab PCR results for SARS-CoV-2 were documented for patients who underwent PEG during the COVID-19 pandemic, both prior to and within the first week after the procedure.\u003c/p\u003e \u003cp\u003eThe date of March 11, 2020, when the World Health Organization officially declared COVID-19 a pandemic, was used as the reference point to divide patients into two groups:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGroup 1\u003c/b\u003e: Patients who underwent PEG before the COVID-19 pandemic.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGroup 2\u003c/b\u003e: Patients who underwent PEG during the COVID-19 pandemic.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eProcedure Technique\u003c/h3\u003e\n\u003cp\u003eIf patients were not receiving antibiotics and had no allergy to β-lactam agents, intravenous cefazolin or ceftriaxone prophylaxis was administered 30 minutes before the procedure. PEG placement was performed using the standard \u003cem\u003epull technique\u003c/em\u003e, guided by transillumination and negative aspiration tests.\u003c/p\u003e \u003cp\u003e During the COVID-19 period, all PEG procedures were conducted according to recommendations from the hospital\u0026rsquo;s Infection Control Committee and contemporary guidelines for endoscopic interventions, ensuring strict adherence to personal protective equipment (PPE) use and infection prevention protocols.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eDemographic data, PEG placement dates, clinical and laboratory parameters, post-procedural complications, and mortality rates at one month and two years were compared between the two study groups. In Group 2, patients were further classified based on SARS-CoV-2 PCR positivity. Monthly distributions of PEG procedures during the two years following the onset of the pandemic were also analyzed. Causes of death were categorized as PEG-related or unrelated.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), minimum, and maximum values, while categorical variables were summarized as numbers and percentages. Differences in continuous variables between two independent groups were analyzed using the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. Survival curves were estimated using the Kaplan\u0026ndash;Meier method, and differences between groups were assessed using the log-rank test. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Associations between categorical variables were analyzed using the chi-square test. A \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 440 patients who met the inclusion criteria were included in this study. Of these, 270 patients underwent PEG before the COVID-19 pandemic (Group 1) and 170 during the pandemic (Group 2). The mean age was 64.5 years (range: 18\u0026ndash;96 years), with 47.5% females (n\u0026thinsp;=\u0026thinsp;209) and 52.5% males (n\u0026thinsp;=\u0026thinsp;231) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen patients were compared according to the timing of PEG placement (pre- vs. post-pandemic), no statistically significant difference was observed in age or sex distribution (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Analysis of diagnostic distribution revealed a significant correlation only between cerebrovascular events (CVE) and respiratory failure (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Evaluation of clinical departments requesting PEG showed significant associations with patients followed by neurosurgery (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and internal medicine (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) clinics. There were no significant differences in ICU admission rates between the two groups.\u003c/p\u003e \u003cp\u003eNo statistically significant association was found between the frequency or type of PEG-related complications and the 1-month prognosis of the patients. Comparison of laboratory parameters demonstrated significant differences in INR, urea, creatinine, total protein, CRP, procalcitonin, and albumin levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas no significant differences were found in other variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSurvival analysis showed that 331 of 440 patients (75.3%) died during follow-up. The median survival time was 114 days (95% CI: 89\u0026ndash;146), with an overall survival probability of 8%. Among patients who underwent PEG before the pandemic, the median survival time was 146 days (95% CI: 107\u0026ndash;199) and survival probability 10%, while those who underwent PEG after the pandemic had a median survival of 69 days (95% CI: 51\u0026ndash;114) and survival probability 17%. This difference was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn total, deaths occurred in 207 of 270 pre-pandemic patients and 124 of 170 post-pandemic patients. The mortality risk was 1.46-fold higher among patients undergoing PEG during the pandemic compared with those before the pandemic (HR: 1.46; 95% CI: 1.16\u0026ndash;1.85) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, evaluation of the CRP/albumin ratio revealed a statistically significant association with mortality (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive analysis of demographic data (n\u0026thinsp;=\u0026thinsp;440)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emin-max\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.65\u0026thinsp;\u0026plusmn;\u0026thinsp;17.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u0026ndash;96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercentage (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifference/Relationship Evaluation According to Pandemic Period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-Pandemic\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;270)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-Pandemic\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;170)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProperties\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSVO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140(51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70(41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdmission department\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCCU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrain Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67(40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWard\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrain Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e241(89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155(91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurried Bumper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrognosis (1st month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197(73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10147.28\u0026thinsp;\u0026plusmn;\u0026thinsp;515.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9335.82\u0026thinsp;\u0026plusmn;\u0026thinsp;344.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.06\u0026thinsp;\u0026plusmn;\u0026thinsp;11.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277.85\u0026thinsp;\u0026plusmn;\u0026thinsp;91.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273.04\u0026thinsp;\u0026plusmn;\u0026thinsp;91.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGlucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136.76\u0026thinsp;\u0026plusmn;\u0026thinsp;49.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137.85\u0026thinsp;\u0026plusmn;\u0026thinsp;54.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUrea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.24\u0026thinsp;\u0026plusmn;\u0026thinsp;31.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.49\u0026thinsp;\u0026plusmn;\u0026thinsp;32.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCreatine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProtein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.71\u0026thinsp;\u0026plusmn;\u0026thinsp;22.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.78\u0026thinsp;\u0026plusmn;\u0026thinsp;14.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.57\u0026thinsp;\u0026plusmn;\u0026thinsp;38.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.41\u0026thinsp;\u0026plusmn;\u0026thinsp;48.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eT.Bil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.52\u0026thinsp;\u0026plusmn;\u0026thinsp;14.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.45\u0026thinsp;\u0026plusmn;\u0026thinsp;18.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.69\u0026thinsp;\u0026plusmn;\u0026thinsp;25.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;121.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322.74\u0026thinsp;\u0026plusmn;\u0026thinsp;146.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e294.31\u0026thinsp;\u0026plusmn;\u0026thinsp;134.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGGT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.86\u0026thinsp;\u0026plusmn;\u0026thinsp;31.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.21\u0026thinsp;\u0026plusmn;\u0026thinsp;22.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109.07\u0026thinsp;\u0026plusmn;\u0026thinsp;87.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115.11\u0026thinsp;\u0026plusmn;\u0026thinsp;88.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProcalcitonin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDeath risk in patients who underwent PEG placement after the pandemic\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurvival rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian Survival\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHazard Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLog Rank\u003c/p\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeriod\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207(76.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(23.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e146(107\u0026ndash;199)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.46(1.14\u0026ndash;1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124(72.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(27.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69(51\u0026ndash;114)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e331(75.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109(24.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114(89\u0026ndash;146)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect of CRP/Albumin ratio on mortality.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;228)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProperties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP/ALB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.61\u0026thinsp;\u0026plusmn;\u0026thinsp;15.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.36\u0026thinsp;\u0026plusmn;\u0026thinsp;14.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe COVID-19 pandemic has had profound and unexpected effects on healthcare systems worldwide (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Owing to infection risks, shortages of protective equipment, and changes in hospital patient profiles, many endoscopy units experienced delays or suspensions of elective procedures (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Endoscopic interventions are classified as high-risk due to the potential for aerosolization and close contact with patients, leading to exposure to infectious respiratory droplets. Therefore, the use of appropriate personal protective equipment (PPE) during such procedures is strongly recommended (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Reports indicate that after implementing strict infection control protocols and limiting elective procedures, the risk of COVID-19 transmission during endoscopy markedly decreased (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePEG remains the preferred method for providing long-term (\u0026gt;\u0026thinsp;30 days) enteral nutritional support (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Neurological dysphagia is the most frequent indication, with underlying causes including stroke, dementia, amyotrophic lateral sclerosis (ALS), Guillain\u0026ndash;Barr\u0026eacute; syndrome, Parkinson\u0026rsquo;s disease, cerebral palsy, myasthenia gravis, encephalitis, meningitis, and polymyositis (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, the indications were consistent with the pre-pandemic period. However, during the pandemic, the number of patients requiring PEG for respiratory failure increased, likely reflecting a shift in the ICU patient profile associated with the higher need for mechanical ventilation. Conversely, PEG placements for cerebrovascular events declined during the same period.\u003c/p\u003e \u003cp\u003ePrevious studies have demonstrated that low serum albumin and elevated C-reactive protein (CRP) levels are independent predictors of both short- and long-term mortality in patients undergoing PEG, irrespective of pandemic conditions (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Consistent with these findings, our study identified a significant association between the CRP/albumin ratio and mortality. Laboratory abnormalities such as elevated INR, urea, creatinine, and acute-phase reactants are expected among critically ill and septic patients (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and similar laboratory patterns were observed in our cohort, particularly during the pandemic.\u003c/p\u003e \u003cp\u003eAlthough no increase in the incidence of PEG-related complications was detected before or after the pandemic, survival curves differed significantly between the two periods. The observed 1.4-fold increase in mortality risk and shortened survival following the pandemic may be attributed to changes in the clinical characteristics of patients undergoing PEG and to disruptions in post-procedural follow-up and continuity of care.\u003c/p\u003e \u003cp\u003eBoth sepsis and COVID-19 have been associated with a prothrombotic state, with critically ill ICU patients being particularly predisposed to thrombotic events. Consequently, antiplatelet and anticoagulant therapies were widely used for treatment and prophylaxis during this period (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In our study, no treatment-requiring bleeding complications were observed, and the overall incidence of hemorrhagic events did not increase. This suggests that PEG placement can be performed safely in patients receiving anticoagulant or antiplatelet therapy when appropriate precautions are followed.\u003c/p\u003e \u003cp\u003eThe pandemic also affected the organization and functioning of hospital wards and ICUs. Many inpatient beds were reallocated for patients with COVID-19 pneumonia, often with multiple comorbidities and critical illness. In our cohort, the distribution of ICU admissions did not differ significantly between groups; however, we observed a notable increase in patients from neurosurgery wards and a decline in those from internal medicine units. This may be explained by the continuation of emergency surgical services and the repurposing of chronic care wards as COVID-19 units.\u003c/p\u003e \u003cp\u003eMortality rates following PEG vary depending on the underlying disease and overall patient condition. Previous studies have reported 30-day mortality rates ranging from 3% to 23% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Poor renal function, anemia, advanced age, high CRP, and low albumin levels are known predictors of early mortality (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The most common causes of death are malignancy and pneumonia (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In our study, median survival was 114 days pre-pandemic and 93 days post-pandemic\u0026mdash;values somewhat lower than those reported in the literature (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This discrepancy may be due to the advanced age and frailty of our study population, as well as the inclusion of critically ill ICU patients. Furthermore, some PEG placements may have been performed without sufficient consideration of near-term mortality predictors.\u003c/p\u003e \u003cp\u003eThe prognostic value of PEG feeding in dementia remains controversial. While some studies suggest that PEG does not improve survival and may even be associated with increased mortality in these patients (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), it continues to be performed for both medical and social reasons. In our study, the high proportion of dementia patients may have negatively influenced overall survival outcomes.\u003c/p\u003e \u003cp\u003eThis study has certain limitations, including its retrospective design, limited follow-up period, and incomplete data regarding medication use and clinical findings. Nevertheless, the large sample size and inclusion of a vulnerable, comorbidity-rich patient population enhance its clinical relevance and contribute valuable insights into PEG practice during pandemic conditions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePercutaneous endoscopic gastrostomy (PEG) remains an effective and safe method for maintaining long-term enteral nutrition. During the COVID-19 pandemic, no increase in procedure-related complication rates was observed, and infection transmission risk was minimized through strict adherence to protective equipment use and preventive measures. However, the pandemic period was associated with a reduction in overall survival time among PEG recipients.\u003c/p\u003e \u003cp\u003eThe C-reactive protein (CRP)/albumin ratio, a recognized short-term mortality marker in PEG candidates, retained its prognostic importance and may aid in identifying patients at higher risk. Our findings underscore the importance of ensuring continuity of nutritional care during pandemics or similar large-scale health crises and provide valuable evidence regarding the safety and clinical relevance of PEG under such conditions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous Endoscopic Gastrostomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOVID-19\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronavirus Disease 2019\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Scientific Research Ethics Committee of Adana City Training and Research Hospital (Approval No: 1961).\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDDC conceived and designed the study.Ş\u0026Ouml; and BS collected the data.MH and BK performed the statistical analysis.EE interpreted the data.DDC drafted the manuscript.All authors critically revised the manuscript and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eFundingThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit. J Thorac Dis. 2021;13(8):5277\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006;25(2):210\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCompher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enter Nutr. 2022;46(1):12\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoeykens K, Duysburgh I. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol. 2021;8(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, et al. Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(2):178\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi IH, Cho YK. Percutaneous Endoscopic Gastrostomy: Procedure, Complications and Management. Brain Neurorehabil. 2022;15(1):e2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaileamlak A. The impact of COVID-19 on health and health systems. Ethiop J Health Sci. 2021;31(6):1073\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYarmus L, Gilbert C, Lechtzin N, Imad M, Ernst A, Feller-Kopman D. Safety and feasibility of interventional pulmonologists performing bedside percutaneous endoscopic gastrostomy tube placement. Chest. 2013;144(2):436\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLipcsey M, Stein DJ, Rosa LY, Anand R, Bilal M, Leibowitz A, et al. High rate of percutaneous gastrostomy placement in COVID-19 patients with low overall complications. Techniques Innovations Gastrointest Endoscopy. 2021;23(4):385\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguila EJT, Lontok MAD, Francisco CPD. Follow Your Gut: Challenges in Nutritional Therapy During the COVID-19 Pandemic. Clin Gastroenterol Hepatol. 2020;18(11):2638\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIyengar K, Mabrouk A, Jain VK, Venkatesan A, Vaishya R. Learning opportunities from COVID-19 and future effects on health care system. Diabetes Metabolic Syndrome: Clin Res Reviews. 2020;14(5):943\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLui RN, Tang RSY, Chiu PWY. Endoscopy After the COVID-19 Pandemic-What Will Be Different? Curr Treat Options Gastroenterol. 2022;20(1):46\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGralnek IM, Hassan C, Beilenhoff U, Antonelli G, Ebigbo A, Pellis\u0026egrave; M, et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy. 2020;52(06):483\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crin\u0026ograve; SF, Gkolfakis P, et al. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc. 2021;13(9):416\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujasinovic M, Ingre C, Baldaque Silva F, Frederiksen F, Yu J, Elbe P. Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre. Scand J Gastroenterol. 2019;54(4):513\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLimpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Fukuhara S, Mutaguchi M, et al. Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy. JGH Open. 2021;5(5):590\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlomberg J, Lagergren P, Martin L, Mattsson F, Lagergren J. Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study. Gastrointest Endosc. 2011;73(1):29\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarasahin O, Tasar PT, Timur O, Binici DN, Yilmaz TK, Aslan A, et al. High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy. Gastroenterol Res. 2017;10(3):172\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Liu H, Liu W, Liu J, Liu K, Shang J, et al. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghua jie he he hu xi za zhi\u0026thinsp;=\u0026thinsp;Zhonghua jiehe he huxi zazhi\u0026thinsp;=\u0026thinsp;Chinese. J tuberculosis respiratory Dis. 2020;43:E005\u0026ndash;E.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorfidia A, Valeriani E, Pola R, Porreca E, Rutjes AWS, Di Nisio M. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb Res. 2020;196:67\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012;47(6):737\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee TH, Shih LN, Lin JT. Clinical experience of percutaneous endoscopic gastrostomy in Taiwanese patients\u0026ndash;310 cases in 8 years. J Formos Med Assoc. 2007;106(8):685\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSbeit W, Kadah A, Mari A, Mahamid M, Khoury T. Simple Bedside Predictors of Survival after Percutaneous Gastrostomy Tube Insertion. Can J Gastroenterol Hepatol. 2019;2019:1532918.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimyagarov S, Levenkron S, Shabi A. [Artificial tube feeding of elderly suffering from advanced dementia]. Harefuah. 2008;147(6):500\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStenberg K, Eriksson A, Odensten C, Darehed D. Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study. BMC Gastroenterol. 2022;22(1):361.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLima DL, Miranda LEC, da Penha MRC, Lima R, Dos Santos DC, Eufr\u0026acirc;nio MS et al. Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy. Jsls. 2021;25(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyman AR, Khoury T, Cohen J, Chen S, Yaari S, Daher S, et al. PEG Insertion in Patients With Dementia Does Not Improve Nutritional Status and Has Worse Outcomes as Compared With PEG Insertion for Other Indications. J Clin Gastroenterol. 2017;51(5):417\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanes SE, Price CS, Khan S. Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors. J Postgrad Med. 2005;51(1):23\u0026ndash;8. discussion 8\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanders DS, Carter MJ, D'Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000;95(6):1472\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFormatting, Notes.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026bull; Font. Times New Roman, 12 pt \u0026bull; Line spacing: 1.5 lines \u0026bull; Alignment: Justified \u0026bull; References: Numbered (Vancouver style) \u0026bull; Figures and Tables: Each on a separate page at the end of the manuscript \u0026bull; Page numbers: Include in the footer before submission.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"PEG, COVID-19, pandemic, complications, mortality","lastPublishedDoi":"10.21203/rs.3.rs-8549527/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8549527/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePercutaneous endoscopic gastrostomy (PEG) is the preferred method for long-term enteral nutritional support in patients unable to maintain adequate oral intake. PEG candidates often present with multiple comorbidities and are at increased risk for complications. Because the procedure requires close patient contact, infection control is critical, especially during pandemics. This study evaluated the impact of the COVID-19 pandemic on PEG procedures and patient outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed patients who underwent PEG at our tertiary gastroenterology center during the two-year periods before and after the onset of the COVID-19 pandemic. Demographic data, laboratory results, complication rates, and mortality were compared between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePEG was performed in 270 patients before the pandemic and 170 during the pandemic. Mean ages were 65.2 and 63.8 years, respectively. Cerebrovascular disease was the most frequent indication in both groups. Median survival significantly decreased during the pandemic (69 vs. 146 days; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). While complication rates remained stable, post-pandemic patients had a 1.46-fold higher mortality risk.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough PEG-related complications did not increase, overall survival declined significantly during the COVID-19 period, likely reflecting changes in patient profiles and reduced care continuity. The C-reactive protein (CRP)/albumin ratio maintained its prognostic value for mortality. These findings emphasize the need for uninterrupted nutritional support and multidisciplinary management during pandemics.\u003c/p\u003e","manuscriptTitle":"Effects of Covid 19 Pandemic on Peg","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 16:40:26","doi":"10.21203/rs.3.rs-8549527/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-04T19:11:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T06:27:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-14T11:34:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T19:09:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-01-13T19:03:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63617f81-7ae1-4bce-a58f-8b21f2cb9167","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:40:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 16:40:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8549527","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8549527","identity":"rs-8549527","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}