The PRINCOVID Retrospective Study

Abstract

Objective The aim of the study is to characterize pressure injuries, identify risk factors, and develop a predictive model for pressure injuries at intensive care unit admission for critical COVID-19 patients. Design This study was a retrospective analysis of a consecutive sample of patients admitted to intensive care unit between May 2020 and September 2021. Inclusion criteria encompassed the diagnosis of acute respiratory distress syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation more than 48 hrs. The following predictors were evaluated: sociodemographic characteristics, comorbidities, as well as clinical and laboratory findings at intensive care unit admission. The primary outcome was the presence of pressure injuries. Results Two hundred five patients were included, mostly males (73%) with a mean age of 62 yrs. Pressure injury prevalence was 58%. On multivariable analysis, male sex, hypertension, hemoglobin, and albumin at intensive care unit admission were independently associated with pressure injuries, constituting the PRINCOVID model. The model reached an area under the receiver operating characteristic curve of 0.71, surpassing the Braden scale (P = 0.0015). The PRINCOVID score ranges from 0 to 15, with two risk groups: “at risk”(≤7 points) and “high risk”(>7 points). Conclusions This study proposes PRINCOVID as a multivariable model for developing pressure injuries in critical COVID-19 patients. Based on four parameters (sex, hypertension, hemoglobin, and albumin at intensive care unit admission), this model fairly predicts the development of pressure injuries. The PRINCOVID score allows patients’ classification into two groups, facilitating early identification of high-risk patients.

Association between hypertension and pressure ulcer: A systematic review and meta‐analysis

“…In the subgroup analysis of patient source, the meta‐analysis results indicated no significant association between hypertension and PU in Asia group (OR = 1.12, 95% CI = 0.83–1.50, I 2 = 63%, p = 0.46) 11 , 12 , 17 , 20 , 22 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 and Non‐Asia group (OR = 1.20, 95% CI = 0.75–1.94, I 2 = 88%, p = 0.45). 10 , 18 , 19 , 21 , 23 , 26 In the subgroup analysis of study design, the results also showed no significant association between hypertension and PU in cohort study (OR = 1.16, 95% CI = 0.84–1.61, I 2 = 63%, p = 0.36) 10 , 11 , 17 , 21 , 22 , 27 , 28 , 31 , 32 and case–control study (OR = 1.14, 95% CI = 0.79–1.64, I 2 = 82%, p = 0.49). 12 , 18 , 19 , 20 , 23 , 24 , 25 , 26 , 29 , 30 Due to the primary disease difference, subgroup analysis was performed based on primary disease, and the results showed that there was a significant association between hypertension and PU in COVID‐19 patients(OR = 1.73, 95% CI = 1.35–2.22, I 2 = 0%, p < 0.0001), 10 , 21 , 26 whereas no association was found in str...…”

“… 10 , 18 , 19 , 21 , 23 , 26 In the subgroup analysis of study design, the results also showed no significant association between hypertension and PU in cohort study (OR = 1.16, 95% CI = 0.84–1.61, I 2 = 63%, p = 0.36) 10 , 11 , 17 , 21 , 22 , 27 , 28 , 31 , 32 and case–control study (OR = 1.14, 95% CI = 0.79–1.64, I 2 = 82%, p = 0.49). 12 , 18 , 19 , 20 , 23 , 24 , 25 , 26 , 29 , 30 Due to the primary disease difference, subgroup analysis was performed based on primary disease, and the results showed that there was a significant association between hypertension and PU in COVID‐19 patients(OR = 1.73, 95% CI = 1.35–2.22, I 2 = 0%, p < 0.0001), 10 , 21 , 26 whereas no association was found in stroke patients(OR = 0.80, 95% CI = 0.29–2.18, I 2 = 72%, p = 0.66), 24 , 30 geriatric disease (OR = 1.32, 95% CI = 0.78–2.24, I 2 = 0%, p = 0.30), 20 , 23 , 28 ICU patients(OR = 0.89, 95% CI = 0.56–1.42, I 2 = 61%, p = 0.62) 17 , 22 , 31 , 32 and surgical patients (OR = 1.10, 95% CI = 0.70–1.73, I 2 = 82%, p = 0.68). 11 , 12 , 18 , …”

Oral pressure injuries in patients hospitalized during the COVID-19 pandemic and associated factors: a cross-sectional study

“…In a study of critically ill COVID patients, the face was commonly affected by LPP and these lesions were related to the use of external devices (such as feeding devices, high-flow endotracheal tubes and standard nasal cannula) and positioning in the prone position (Teixeira-Vaz et al, 2023). According to systematic reviews of oral manifestations in COVID patients, ulcerative lesions, including those of traumatic origin, have been found (Gupta et al, 2023;Kot et al, 2023), but without a specific diagnosis.…”

“…However, It is essential to emphasize the importance of quality ICU care for patients with comorbidities in order to prevent the occurrence of PPL, including in the oral cavity. In a study evaluating a predictive model for PPL in critically ill COVID patients, arterial hypertension was a potential factor associated with these lesions (Teixeira-Vaz et al, 2023).…”

“…Since 5% of patients with Coronavirus Disease (COVID) have a respiratory manifestation that evolves into Severe Acute Respiratory Syndrome (SARS) (Guan et al, 2020), oxygen support and ICU admission for clinical and hemodynamic stabilization are necessary (Yiğitoğlu;Aydoğan, 2023). Thus, in the need for non-invasive mechanical ventilation or invasive ventilation with the use of an endotracheal tube, the appearance of LPO can occur (Ferreira et al, 2023;Yiğitoğlu;Aydoğan, 2023), and more frequently in the oral cavity and mouth (Yiğitoğlu;Aydoğan, 2023;Teixeira-Vaz et al, 2023).…”