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Determinants of pressure injury development in patients with COVID-19
Lee H Kilmer1, Ankita Samuel1, Grace L Forster2
1Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US.
Insights
Pressure injuries (PIs) are common in critically ill COVID-19 patients, particularly those with comorbidities. Most patients do not receive surgical treatment for these injuries, highlighting a gap in care.
Area of Science:
- Critical Care Medicine
- Epidemiology
- Wound Healing Research
Background:
- Pressure injuries (PIs) are a significant concern in critically ill patients, exacerbated by immobility and comorbidities affecting tissue perfusion.
- The COVID-19 pandemic has presented unique challenges in managing critically ill patients, potentially increasing the risk of PIs.
Purpose of the Study:
- To determine the epidemiological factors associated with the development of PIs in patients diagnosed with COVID-19.
- To investigate current management practices for PIs in this patient population.
Main Methods:
- Utilized a US national insurance-based database of patients diagnosed with COVID-19 between 2019-2020.
- Queried for subsequent PI diagnosis and analyzed demographic data, comorbidities, and intensive care unit (ICU) admission.
- Employed logistic regression to identify predictors of PI development and operative debridement.
Main Results:
- Over 1.4 million COVID-19 patients were analyzed, with 1.06% developing PIs, often in ICU patients.
- Key predictors for PI development included diabetes, hypertension, chronic kidney disease, depression, and critical illness indicators like ICU admission and sepsis.
- Surgical debridement was infrequent, even for severe cases, with factors like ICU admission, sepsis, and PI location influencing its likelihood.
Conclusions:
- Pressure injuries are highly prevalent among COVID-19 patients, especially the critically ill.
- Despite high prevalence, the majority of COVID-19 patients with PIs do not undergo operative interventions, indicating a need for improved management strategies.
Objective:
Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19.
Method:
A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement.
Results:
A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage.
Conclusion:
PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures.
Declaration Of Interest:
The authors have no conflicts of interest to declare.
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