Related Experiment Video
Updated: Jan 15, 2026
Mouse Model of Pressure Ulcers After Spinal Cord Injury
Published on: March 9, 2019
Risk factors and predictive model for pressure injuries in ICU patients with a Braden score ≤9 based on initial serum
Jiang Yifan1, Li Juan2, Tai Rui1
1Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
This study identified key serum biomarkers and clinical factors to predict pressure injuries (PIs) in intensive care unit (ICU) patients with low Braden scores. The developed model aids early risk identification for targeted nursing interventions.
Area of Science:
- Critical Care Medicine
- Nursing Research
- Biomarker Discovery
Background:
- Pressure injuries (PIs) are a significant concern in intensive care units (ICUs), particularly for patients with low Braden scores (≤9).
- Early identification of high-risk patients is crucial for implementing timely and effective preventive nursing interventions.
- Existing risk assessment tools may not fully capture the complex interplay of factors contributing to PI development in critically ill patients.
Purpose of the Study:
- To investigate the association between initial serum biomarkers and clinical variables on admission with the development of PIs in ICU patients with a Braden score ≤9.
- To develop and validate a predictive model for PI risk stratification in this vulnerable patient population.
- To support the implementation of personalized nursing strategies for early PI prevention.
Main Methods:
- Retrospective analysis of 290 ICU patients (Braden score ≤9) from six tertiary hospitals (January 2020 - January 2024).
- Patients were categorized into PI (n=115) and non-PI (n=175) groups.
- Logistic regression analysis was employed to identify independent risk factors and construct a predictive model, with performance assessed using Receiver Operating Characteristic (ROC) analysis.
Main Results:
- Independent risk factors for PI included older age, lower serum sodium and calcium, elevated white blood cell count, increased glutamate and alanine, positive intestinal pathogen colonization, mechanical ventilation, and physical restraints (all P < 0.05).
- The developed logistic prediction model demonstrated strong discrimination (AUC = 0.910) and good fit.
- The model was operationalized into three risk tiers (low, intermediate, high) with corresponding bedside actions.
Conclusions:
- Initial serum biomarkers and clinical features effectively identify ICU patients at high risk for PIs, even with low Braden scores.
- The validated predictive model offers strong clinical applicability and discriminative power for precision nursing.
- This study provides a clinically actionable risk-to-action protocol to enhance PI prevention strategies in ICUs.
Objective:
To explore the association between initial serum biomarkers at admission and the development of pressure injuries (PIs) in intensive care unit (ICU) patients with a Braden score ≤9, and to construct a predictive model for PI risk. The goal is to support early identification and personalized nursing interventions for high-risk individuals.
Methods:
A retrospective study of 290 ICU patients with a Braden score ≤9 admitted to six tertiary hospitals in Shanghai between January 2020 and January 2024. Patients were divided into a PI group (n = 115) and a non-PI group (n = 175) based on whether they developed a pressure injury. Demographic characteristics, clinical interventions, and laboratory data on the day of admission were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors and to build a predictive model, with model performance evaluated via receiver operating characteristic (ROC) analysis.We developed a bedside-applicable logistic prediction model using admission-day variables and, after model estimation, derived risk thresholds from the ROC coordinate table to enable three-tier risk stratification.
Results:
Independent risk factors for pressure injury included older age, lower serum sodium and calcium levels, elevated white blood cell count, increased glutamate and alanine levels, positive intestinal pathogen colonization, use of mechanical ventilation, and application of physical restraints (all P < 0.05). The final logistic regression model showed good fit (Hosmer-Lemeshow test, P = 0.807) and strong discrimination (AUC = 0.910, 95 % CI: 0.877-0.943), with a sensitivity of 81.7 % and specificity of 86.9 %.The model showed excellent discrimination (AUC 0.910) and was operationalized into low (P < 0.3426), intermediate (0.3426≤P < 0.5720), and high risk (P ≥ 0.5720), each mapped to specific bedside actions.
Conclusion:
Among ICU patients with a Braden score ≤9, initial serum biomarkers combined with key clinical features can effectively identify individuals at high risk of pressure injuries. The predictive model developed in this study demonstrates strong clinical applicability and discriminative power, providing scientific support for precision nursing interventions.This study provides a clear, clinically actionable risk-to-action protocol for ICU patients with Braden scores ≤9.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:22Acute Kidney Injury I: Introduction