Fibrosis-4 (FIB-4) Score and Hepatic Biomarkers Can Be Used as a Prognostic Indicator for ICU Patients Undergoing PEG to Predict All-Cause Mortality: A Retrospective Cross-Sectional Study

Background/Objectives: This study evaluated prognostic mortality indicators in patients undergoing percutaneous endoscopic gastrostomy (PEG) in the intensive care unit (ICU), focusing on hepatic fibrosis and biochemical parameters. Methods: A retrospective analysis of 149 ICU patients undergoing PEG was performed, and the patients were categorized as survivors (n=88) and non-survivors (n=61). The clinical, demographic, and baseline lab parameters and scores, including the Fibrosis-4 score (FIB-4), albumin, gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LDH) levels, were analyzed and compared between the groups to determine their association with all-cause mortality. Results: Older age, higher FIB-4, plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), procalcitonin, international normalized ratio (INR), prothrombin time (PT), and lower calcium, platelet, and albumin levels were all significantly associated with all-cause mortality. The Receiver Operating Curve (ROC) analysis identified the FIB-4, GGT, LDH, and albumin as significant predictors of all-cause mortality. The Kaplan-Meier analysis also demonstrated that PEG patients with higher FIB-4, GGT, LDH, and lower albumin levels had significantly shorter survival. Logistic regression analysis showed that higher FIB-4, GGT, and LDH levels are independent risk factors for mortality, while higher albumin levels are protective. When these four parameters were compared concerning their predictive abilities for all-cause mortality, FIB-4 was superior to GGT and LDH, while albumin had the highest ability to estimate survival probability. Conclusion: FIB-4, GGT, LDH, and albumin levels are important prognostic indicators of all-cause mortality in ICU patients undergoing PEG. These findings emphasize the importance of the early identification of these parameters in this high-risk patient population.