Prognostic value of fibrosis-4 index, hepatic biomarkers, and plasma acute-phase reactants in critical patients undergoing percutaneous endoscopic gastrostomy: a retrospective cohort study

Abstract

Background/Objectives: Identifying reliable predictors of all-cause mortality in intensive care unit (ICU) patients undergoing percutaneous endoscopic gastrostomy (PEG) remains clinically important to decide the route of nutrition. This study aimed to assess the prognostic significance of hepatic biomarkers, particularly the Fibrosis-4 (FIB-4) score. Methods: We conducted a retrospective cohort study in the ICUs of a tertiary care university hospital. Adult patients who underwent PEG between 1 January 2022 and 31 December 2024 were included. Pre-procedural demographic, clinical, and laboratory data were retrieved from electronic medical records. The primary outcome was all-cause mortality within three years of PEG placement. Survival analyses were performed using Kaplan–Meier curves and Cox proportional hazards regression to identify independent predictors. Results: Older age, elevated FIB-4, total and direct bilirubin, gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), ferritin, c-reactive protein (CRP), procalcitonin, INR, and prothrombin (PT) levels, and reduced calcium, platelet count, and albumin were significantly associated with all-cause mortality (p < 0.05). ROC analysis identified FIB-4, GGT, LDH, and albumin as significant predictors of mortality. Kaplan–Meier analysis confirmed that patients with higher FIB-4, GGT, and LDH, and lower albumin levels, had significantly shorter survival. Cox proportional hazards regression analysis revealed that while the FIB-4 score was a significant predictor of mortality in the univariate model, it lost its independent prognostic value when adjusted for confounders. Instead, lower albumin, elevated CRP, and increased GGT emerged as the independent risk factors for mortality. Conclusions: Pre-procedural albumin, CRP, and GGT levels are strong independent prognostic indicators of all-cause mortality in ICU patients undergoing PEG. While FIB-4 serves as a practical initial screening tool, adverse outcomes might be primarily driven by systemic inflammation and nutritional depletion rather than isolated hepatic fibrosis.