Multifactorial Risk Assessment of Hospital-Acquired Pressure Injuries Among High-Risk Patients: A Case-Control Study

Background: Pressure injuries are a major patient safety concern, particularly among hospitalized patients at high risk. Identifying factors associated with pressure injuries is essential for effective prevention. Therefore, this study aimed to identify factors associated with pressure injuries among high-risk hospitalized patients. Methods: A case-control study was conducted among 80 inpatients, including 40 with hospital-acquired pressure injuries (HAPIs) and 40 without HAPIs, admitted to the Department of Medicine, Mahasarakham Hospital, between April 2023 and December 2025. Data were obtained from medical records and structured data collection forms. Descriptive statistics and bivariable analyses using chi-square or Fisher's exact tests were performed. Variables with p < 0.25 were considered for multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Patients with HAPIs had higher proportions of edema, incontinence, hypoalbuminemia, and nil per os (NPO) status. Bivariable analysis identified associations with Braden score ≤17, impaired level of consciousness, mechanical ventilation, inotropic/vasopressor use, physical restraint, edema, incontinence, low serum albumin, and NPO status (p < 0.05). In the final multivariable model, endocrine and metabolic diseases (AOR = 25.92; 95% CI: 1.06-633.10; p = 0.046), mechanical ventilator use (AOR = 104.79; 95% CI: 11.78-932.05; p < 0.001), inotropic/vasopressor use (AOR = 17.26; 95% CI: 1.15-258.41; p = 0.039), and diarrhea (AOR = 24.34; 95% CI: 1.88-315.36; p = 0.015) were statistically associated with HAPIs. Cardiovascular diseases showed a borderline association (AOR = 18.78; 95% CI: 1.00-354.36; p = 0.050), while physical restraint was not statistically significant (AOR = 5.40; 95% CI: 0.80-36.66; p = 0.084). Conclusions: Several clinical factors were associated with HAPIs. However, large AORs and wide CIs indicate substantial uncertainty in the magnitude of these associations. Findings should be interpreted cautiously and confirmed in larger prospective studies. Prevention should emphasize early risk identification, management of critically ill patients, and appropriate moisture and pressure injury prevention.