Impact of Percutaneous Endoscopic Gastrostomy (PEG) Timing on Mortality in Intensive Care Unit Patients: The Modifying Role of the Prognostic Nutritional Index (PNI).

BACKGROUND: This study investigated the effect of percutaneous endoscopic gastrostomy (PEG) timing on mortality in ICU patients and the moderating role of the Prognostic Nutritional Index (PNI). METHODS: In this analysis of 487 ICU patients receiving PEG, cohorts were stratified into early (≤14 days; n=146) and late (>14 days; n=341) groups. Multivariate regression and stratification analyses were employed to assess 30-day and 1-year mortality, adjusting for demographic, clinical (APACHE II), and nutritional (PNI) parameters. RESULTS: The late PEG group demonstrated significantly higher disease severity (APACHE II 22.7 vs. 19.2, p<0.001) and lower PNI scores (32.8 vs. 35.7, p<0.001). Thirty-day mortality was significantly elevated with late placement (31.7% vs. 15.1%, p<0.001). Multivariate analysis identified late PEG (OR: 2.21, p=0.001), PNI<33 (OR: 2.84, p<0.001), and APACHE II>20 (OR: 3.12, p<0.001) as independent mortality predictors. A significant interaction was observed between timing and nutrition; the protective effect of early PEG was most pronounced in patients with PNI≥33 (OR: 5.96, p<0.001; interaction p=0.012). Complication rates were comparable. CONCLUSION: Early PEG placement is associated with significantly reduced mortality in ICU patients, particularly among those with better baseline nutritional status (PNI≥33). The PNI serves as a practical biomarker to guide personalized decision-making for optimal PEG timing.