Incidence and risk factors of pressure injuries in critically ill patients with COVID-19

Ramalho, Aline de Oliveira; Fonseca, Rodrigo Augusto Gonçalves; Mazócoli, Eliane; Marin, Alessandra; Nogueira, Paula Cristina

doi:10.1590/0034-7167-2022-0553

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (Suppl 1) • 2023 • https://doi.org/10.1590/0034-7167-2022-0553 copy

Incidence and risk factors of pressure injuries in critically ill patients with COVID-19

Incidencia y factores de riesgo de lesiones por presión en pacientes críticos con COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs.

Method:

a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI.

Results:

PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001).

Conclusion:

PI incidence in critically ill patients with COVID-19 was high.

Descriptors:
Intensive Care Units; COVID-19; Incidence; Pressure Ulcer; Nursing Care

Variable	Without PI (n: 466)	With PI (n: 202)	p value
Clinical profile
Age in years (M-SD)	61.2 (14.6)	71.9 (11.7)	<0.001*
Sex (male)	362 (77.7%)	156 (77.2%)	0.897**
Sex (female)	104 (22.3%)	46 (22.8%)	0.897**
Ethnicity (white)	388 (93.3%)	172 (96.6%)	0.215***
Hypertension	233 (50%)	122 (60.4%)	0.013**
Diabetes Mellitus	123 (26.4%)	78 (38.6%)	0.002**
Chronic kidney failure	23 (4.9%)	18 (8.9%)	0.049**
Immunosuppression	14 (3%)	16 (7.9%)	0.005**
Cardiac insufficiency	5 (1.1%)	3 (1.5%)	0.703*****
Chronic obstructive pulmonary disease	3 (0.6%)	5 (2.5%)	0.059*****
Dyslipidemia	120 (25.8%)	55 (27.2%)	0.690**
Screening and risk assessment tools
BMI (M-SD)	29.5 (5.2)	29.1 (5.3)	0.411****
MFI (M-SD)	0.10 (0.11)	0.13 (0.10)	<0.001****
SAPS 3 (probability of death) (M-SD)	13.4 (12.3)	24.8 (16.8)	<0.001****
ICU admission SOFA (M-SD)	2.4 (2.9)	5.3 (3.3)	<0.001****
Nutritional risk	183 (40.7%)	100 (49.8%)	0.031**
NRS 2002 (with risk)
Braden Scale on admission (high risk)	41 (9.7%)	64 (35.8%)	0.001****
Intensive support
High flow nasal catheter	352 (75.5%)	156 (77.2%)	0.638**
Mechanical ventilation	173 (37.1%)	183 (90.6%)	<0.001**
Non-invasive ventilation	330 (70.8%)	157 (77.7%)	0.065**
Sedation	180 (38.6%)	185 (91.6%)	<0.001**
Prone	40 (8.6%)	67 (33.2%)	<0.001**
Neuromuscular blocker	135 (29%)	159 (78.1%)	<0.001**
ECMO	6 (1.3%)	21 (10.4%)	<0.001**
CRRT	12 (2.6%)	47 (23.3%)	<0.001**
Hospital admission outcome
Hospital days admitted to the ICU (M-SD)	8.3 (8.2)	25.6 (18.9)	<0.001****
Total hospital admission days (M-SD)	22.3 (22.2)	47.3 (34)	<0.001****
Outcome in the ICU (death)	14 (3%)	47 (23.3%)	<0.001**

Variable	p value after logistic regression	Odds Ratio	IC 95%
Clinical profile
Age in years	<0.001	1.06	1.03 – 1.08
Diabetes Mellitus	0.005	2.07	1.24 – 3.43
Immunosuppression	0.034	3.40	1.10 – 10.55
Screening and risk assessment tools
Nutritional risk - NRS 2002	0.015	1.99	1.14 – 3.48
Risk score for PI on admission (reference is high risk)
No risk	0.039	0.43	0.19 – 0.96
Low risk	0.002	0.36	0.19 – 0.68
Moderate risk	0.326	0.68	0.32 – 1.46
Intensive support
Mechanical ventilation	<0.001	3.52	1.80 – 6.88
Hospital admission outcome
Hospital days admitted to the ICU	<0.001	1.11	1.07 – 1.14

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[1] Corresponding author: Aline de Oliveira Ramalho E-mail: alineo_ramalho@hotmail.com