Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital

Abstract

A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were “days of norepinephrine” with an odds ratio (OR) of 1.625 (95% CI: 1.473–1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779–0.857), “days of mechanical ventilation” with an OR of 1.521 (1.416–1.634) and AUC of 0.879 (0.849–0.909), “ICU stay (days)” with an OR of 1.279 (1.218–1.342) and AUC of 0.846 (0.812–0.881), and “Braden’s sensory perception” with an OR of 0.345 (95% CI: 0.278–0.429) and AUC of 0.760 (0.722–0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.

The Impact of COVID-19 on Rates of Pressure Injuries Among Hospitalized Patients across the US

“…In addition, patients with HAPIs were more often discharged to a skilled nursing facility and less often to their home or under self-care. These findings are consistent with current literature describing risk factors for HAPIs, including patients with various comorbidities and critical illness requiring admission to the ICU 19,21,22 . There were no significant differences between all admitted patients and those with HAPIs according to race.…”

“…These findings are consistent with current literature describing risk factors for HAPIs, including patients with various comorbidities and critical illness requiring admission to the ICU. 19,21,22 There were no significant differences between all admitted patients and those with HAPIs according to race. These findings suggest that patients who develop HAPIs share similar characteristics; most notably, they seem to experience more healthcare comorbidities than the general admitted patient population, which did not change across the time period.…”

Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis

“…Hu et al reported COPD to be associated with an increased risk of pressure injury at the sacral region (OR 3.2, 95% CI 1.3 to 8.0) with an association stronger than the Braden score and multiorgan dysfunction syndrome 32 . Argenti et al also reported COPD to be associated with pressure injury risk in univariate analysis (OR 2.6, 95% CI 1.8 to 3.9) but these data were not further explored in multivariable analysis 33 .…”

The Direct Effects of Norepinephrine Administration on Pressure Injuries in Intensive Care Patients: A Retrospective Cohort Study

“…The data set was from a previous single-center cohort study of prognostic factors to evaluate the risk of developing PIs in intensive care patients. 24 This retrospective data set contained participants' longitudinal data from hospital admission to ICU discharge from their medical records. Regarding the exploratory analysis of this data set, linear paths among variables were hypothesized to investigate the causal links from norepinephrine to HAPI incidence.…”

“…The data set was from a previous single-center cohort study of prognostic factors to evaluate the risk of developing PIs in intensive care patients 24 . This retrospective data set contained participants’ longitudinal data from hospital admission to ICU discharge from their medical records.…”