Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis.

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Publisher: Elsevier B.V.
Document Type: Article
Length: 819 words

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on behalf of the Keywords Pressure injuries; COPD; Intensive care; Comorbidity; Decubitus ulcers Abstract Background Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. Objective To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. Study design and methods This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). Results Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). Conclusion and implications Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis. Author Affiliation: (a) Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland (b) Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK (c) Faculty of Medicine & Health Science, Department of Internal Medicine, Ghent University, Ghent, Belgium (d) Hadassah Hebrew University Medical Center, Jerusalem, Israel (e) Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK (f) Intensive Care Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK (g) Medical Intensive Care Unit, University Hospital of Grenoble-Alpes, Grenoble, France (h) Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia (i) School of Nursing, Queensland University of Technology and Intensive Care Services (ICS), Royal Brisbane and Women's Hospital, Herston, Australia (j) Nursing Department, Universitat Internacional de Catalunya, Barcelona, Spain (k) Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia (l) Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK (m) South Metropolitan Health Service, Perth, and School of Nursing and Midwifery, Griffith University, Australia (n) Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium (o) Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium (p) Nursing Department, Faculty of Education, Health and Social Work, HOGENT University of Applied Sciences and Arts, Ghent, Belgium (q) Department of Internal Medicine and Pediatrics, Faculty of Medicine, Burns Trauma and Critical Care Research Centre, Ghent University, The University of Queensland, Campus UZ Gent, Corneel Heymanslaan 10, Brisbane 9000, Australia (r) Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain (s) Neonatal Intensive Care Unit, Rosie Maternity, Cambridge University Hospitals NHS Trust, Cambridge, UK (t) Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK (u) School of Nursing, Midwifery, Paramedicine University of the Sunshine Coast, Queensland, Australia (v) Department of Critical Care, McGill University Health Centre and Department of Critical Care, Faculty of Medicine, McGill University, Montreal, Canada * Corresponding author. Article History: Received 30 November 2021; Revised 28 February 2022; Accepted 1 March 2022 (footnote) Clinical Trial Registration: DecubICUs was registered at ClinicalTrials.gov (NCT03270345). (footnote) Tweet: #ICU patients with #COPD have significantly higher risk pressure injury; those that develop pressure injury are at higher risk of mortality Byline: Ignacio Martin-Loeches (a,r), Louise Rose (b), Elsa Afonso (c,s), Julie Benbenishty (d), Bronagh Blackwood (e), Carole Boulanger (f), Silvia Calvino-Gunther (g), Wendy Chaboyer (h), Fiona Coyer (i,t), Mireia Llaurado-Serra (j), Frances Lin (k,u), Francesca Rubulotta (l,v), Ged Williams (m), Mieke Deschepper (n), Guy Francois (o), Sonia O. Labeau (p), Stijn I. Blot [stijn.blot@UGent.be] (q,*)

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Gale Document Number: GALE|A700885979