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Pressure sore patients versus control group
Source publication
Spinal cord injury (SCI) patients with pressure sores were studied before and after surgical intervention for ulcer healing and compared with matched SCI patients without sores and with patients with pressure sores and other diseases.
To analyse the relationship between pressure sores and anaemia and serum protein alteration in SCI patients. To stu...
Contexts in source publication
Context 1
... to the control group, the patients with pressure sores showed anaemia with reduced serum iron, increased ferritin and reduced transferrin and transferrin saturation (Table 1). ...
Context 2
... also had increased ESR and CRP, total hypoproteinemia, hypoalbuminemia, increased alfa-1 and gamma globulins and reduced albumin/globulin ratio (Table 1). No statistically significant correlation was found between serum protein alteration and decubitus ulcer areas (r ¼ 0.087). ...
Citations
... The need for functional assessment is particularly pronounced in conditions such as spinal shock, where the neurological status may be uncertain. In addition to these functional indicators, our study also draws attention to the importance of pre-onset laboratory markers related to inflammation and anemia, such as lymphocyte, neutrophil and eosinophil counts, as well as MCHC and RBC counts, which is consistent with the findings of a previous study [37]. Although not primary predictors, their association with increased PU risk is consistent with previous research and underscores their importance in PU risk assessment. ...
(1) Background: Pressure ulcers (PUs) substantially impact the quality of life of spinal cord injury (SCI) patients and require prompt intervention. This study used machine learning (ML) techniques to develop advanced predictive models for the occurrence of PUs in patients with SCI. (2) Methods: By analyzing the medical records of 539 patients with SCI, we observed a 35% incidence of PUs during hospitalization. Our analysis included 139 variables, including baseline characteristics, neurological status (International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI]), functional ability (Korean version of the Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]), and laboratory data. We used a variety of ML methods—a graph neural network (GNN), a deep neural network (DNN), a linear support vector machine (SVM_linear), a support vector machine with radial basis function kernel (SVM_RBF), K-nearest neighbors (KNN), a random forest (RF), and logistic regression (LR)—focusing on an integrative analysis of laboratory, neurological, and functional data. (3) Results: The SVM_linear algorithm using these composite data showed superior predictive ability (area under the receiver operating characteristic curve (AUC) = 0.904, accuracy = 0.944), as demonstrated by a 5-fold cross-validation. The critical discriminators of PU development were identified based on limb functional status and laboratory markers of inflammation. External validation highlighted the challenges of model generalization and provided a direction for future research. (4) Conclusions: Our study highlights the importance of a comprehensive, multidimensional data approach for the effective prediction of PUs in patients with SCI, especially in the acute and subacute phases. The proposed ML models show potential for the early detection and prevention of PUs, thus contributing substantially to improving patient care in clinical settings.
... Patients with pressure ulcers usually demonstrate significantly impaired physical and social function, self-care, and mobility [17]. Common associated morbidities include pain, depression, local infection, anemia, osteomyelitis, and sepsis [14,[18][19][20][21]. In addition, patients with pressure ulcers often require either long-term hospitalization or frequent hospital admissions. ...
The immobility of patients confined to continuous bed rest continues to raise a couple of very serious challenges for modern medicine. In particular, the overlooking of sudden onset immobility (as in acute stroke) and the delay in addressing the underlying conditions are of utmost importance for the patient and, in the long term, for the medical and social systems. This paper describes the design principles and concrete implementation of a new smart textile material that can form the substrate of intensive care bedding, that acts as a mobility/immobility sensor in itself. The textile sheet acts as a multi-point pressure-sensitive surface that sends continuous capacitance readings through a connector box to a computer running a dedicated software. The design of the capacitance circuit ensures enough individual points to provide an accurate description of the overlying shape and weight. We describe the textile composition and circuit design as well as the preliminary data collected during testing to demonstrate the validity of the complete solution. These results suggest that the smart textile sheet is a very sensitive pressure sensor and can provide continuous discriminatory information to allow for the very sensitive, real-time detection of immobility.
... In our study, ESBL positivity was found 22.20% in Escherichia coli strains (2 of 9 strains), ESBL positivity was not found in Klebsiella strains. Especially Escherichia coli and Klebsiella strains showed 50% resistance to Ampicillin, Cefazolin, Cefepime, Ceftriaxone, and Ciprofloxacin.Scivoletto et al. and Gürçay et al. found high WBC, CRP, and ESR in patients with pressure ulcer infection.18,19 In our study, we found that WBC, CRP, and ESR increased in patients with reproductive decubitus ulcer infection, which was consistent with the studies in the literature.Pressure ulcer infections continue to be a health problem that reduces the quality of life in long-term care patients, despite the development of prevention and treatment methods.20 ...
INTRODUCTION: In our study, it was aimed to examine the distribution of infectious microorganisms, and antibiotic resistance status in palliative care patients with pressure ulcers followed in Ankara Polatlı Duatepe State Hospital Palliative Care Service in 2019- 2020. METHODS: The sex, age, and detected diseases of a total of 178 palliative care patients included in our study were analyzed retrospectively. For determining the causative agents of pressure ulcer infections in these patients, Gram staining was performed on the bacterial cultures that developed in the wound samples, and the Vitek-2 (bioMérieux, France) automatic test device was used to identify these cultures and determine their antibiotic susceptibility. RESULTS: It was observed that the single-agent microorganism grew in 26 of the cultures. When the 26 active microorganisms we detected in the wound culture growths were examined; it was observed that Escherichia coli (n=9, 34.62%) and Proteus mirabilis (n=3, 11.54%) grew more frequently in enteric bacteria and Pseudomonas aeruginosa (n=3, 11.54%) in non-fermentative bacteria. In our study, the absence of antibiotic resistance in Pseudomonas aeruginosa isolates was considered remarkable. In our study, 100% resistance was found to antibiotics such as Ampicillin, Cefepime, Ceftriaxone, Ciprofloxacin, Amoxicillin-clavulanate, and Gentamicin in gram (+) bacteria, while 100% resistance was found against antibiotics such as Ceftriaxone, Ciprofloxacin, and Trimethoprim/sulfamethoxazole in gram (-) bacteria. DISCUSSION AND CONCLUSION: In the treatment of infection pressure ulcers, starting antibiotic therapy at the appropriate time and choosing the right antibiotic is one of the most important factors that determine the success of treatment.
... Even if nutrition did not emerge as frequently as mobility status and perfusion in systematic reviews about pressure sores, nevertheless it remains an important issue [15]. Also, laboratory abnormalities such as low serum albumin, hemoglobin, cholesterol, iron and zinc deficiencies are frequently found in patients with pressure sores [16][17][18][19][20][21]. ...
Introduction:
Motor and swallowing dysfunctions in multiple sclerosis (MS) unbalance calories intakes and energy expenditure, modifying nutritional status (NS). Only one study described NS in MS patients at early stages (median EDSS = 3), but this has never been assessed in the most severe. The goal of the present study was to describe NS in advanced-stage MS.
Methods:
The study is a non-interventional retrospective analysis of a prospective registry. We reviewed medical files of consecutive MS patients admitted for annual follow-up in a physical and rehabilitation medicine unit between May 2016 and October 2018. Malnutrition for frail people, according to the French Health Authority (HAS) definition was our composite primary outcome criterion: Body Mass Index (BMI)<21kg/m2 and/or albumin<35g/l. First, we performed a descriptive analysis of the nutritional status. Second, we studied the association between malnutrition and MS characteristics in univariate and multivariate analyses.
Results:
163 patients with median EDSS=8 [7; 8.5] were included. Ninety-three patients (57%) met HAS malnutrition criterion (36% with albumin<35g/l, 31% with BMI<21kg/m2 and 10% with both). Malnutrition was associated in univariate analysis with MS severity (EDSS≥8.5 (p=0.0003)), primary progressive type of MS (p=0.01) and swallowing disorders (p=0.002). Multivariate analysis showed that low disability status (EDSS < 7) was the only independent (protective) factor associated with malnutrition (OR = 0.2, p=0.03).
Conclusion:
Malnutrition is frequent in advanced stages of MS and probably a key point for therapeutics, which has never been demonstrated before. A standardized evaluation should be developed to improve nutritional therapeutic strategies in this population.
... Indirect causes -Physiological changes related to age -weakening of the blood vessel walls and connective tissue and loss of fat and muscle; -Conditions associated with prolonged wound healing such as diabetes mellitus [2]; -Any disease causing a low oxygen level in the blood such as chronic obstructive pulmonary disease, cardiac failure, myocardial infarction [2]; -Malnutrition may lead to hypoproteinemia and anemia causing a delay in the wound healing process [7]; -Moisture [5]; -Mental health conditions -due to the poor diet and neglection of personal hygiene. The severity of the pressure ulcers can be assessed using the EPUAP (European Pressure Ulcer Advisory Panel) grading system, which classifies them into four categories [2]. ...
Introduction: Pressure sores have been defined as areas of localized soft tissue ischemic necrosis caused by prolonged pressure related to posture, which usually occur over a bony prominence. The most affected areas are those that undergo a lot of tension such as trochanters, sacrum, malleoli, heels and occiput. Most people that are affected by pressure sores have an underlying pathology that makes them immobile, confining them to chairs or bed for longer periods of time. Pressure ulcers may have direct causes (pressure, shear, friction, immobility, loss of sensation) or indirect causes. Case presentation: This paper will present the case of a 53-year-old male. After about 3 weeks of being immobilized in bed in dorsal decubitus due to an acute respiratory distress which required intubation and mechanical ventilation, the patient developed very large pressure sores on the left sacral and buttock area and left sole. He was treated in the outpatient department using multiple therapeutic protocols based on the alternation of antibiotic creams and modern absorbent dressings. Conclusions: The evolution of this patient was long but favorable, the left sacral and buttock area eschar closing completely while the sole eschar had a good evolution, but is still undergoing treatment.
... Other possible explanations, that need to be verified with appropriate studies are: (1) the patients with complications have a longer length of stay but nonetheless receive less hour of rehabilitation or less intensive rehabilitation than their counterparts without complications. (2) As it has been demonstrated [46] that complications, in particular pressure ulcers induce a chronic inflammatory state with anemia, low serum iron, hypoproteinemia, and hypoalbuminemia, it is possible that this long-lasting suffering disrupts the functional potential of the patients. With regard to neurological status, we found a difference in neurological outcome of our patients with patients without complications having a significantly higher MS gain and a higher percentage of AIS grade conversion than patients without complications. ...
... They attributed this phenomenon to the systemic inflammation induced by infections as demonstrated also by experimental models [47]. As other complications and, in particular, pressure ulcers (that represented the most frequent complications in our database) may induce a chronic inflammatory state [46], it is possible that other complications beside infections may negatively impact on neurological recovery. However, this hypothesis needs to be verified in further specific studies, because we cannot exclude that this result could be due to the effect of other confounders. ...
Retrospective cohort study.
Aim of the study is to evaluate the impact of complications at admission on the functional status of spinal cord lesions patients.
Rehabilitation hospital in Italy.
Two hundred and seven patients with complications (mostly pressure ulcers) at admission to rehabilitation were matched for neurological level of injury and AIS grade with 207 patients without complications. Measures: International Standards for Neurological Classification of Spinal Cord Injury, Spinal Cord Independence Measure, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. These measures were recorded at admission to rehabilitation and at discharge. We also recorded length of acute and rehabilitation stay and discharge destination. Statistics: Student’s T test for paired samples, McNemar’s chi-square test.
Patients with complications at admission suffered more often from a traumatic lesions. The functional status at admission and discharge of the patients without complications was significantly better than the functional status of patients with complications (Spinal Cord Independence Measure mean difference between the two groups 5.7 (CI 2.8–8.5) at admission, and 10 (CI 5.3–14.7) at discharge). Length of stay was significantly higher in patients with complications. Patients with complications were more often institutionalized than their counterparts (46/161 vs. 20/187, odds ratio 0.4 (CI 0.2–0.7)).
Complications seem to be more frequent in patients with traumatic lesions. The presence of complications has a negative effect on patients’ functional status at discharge and length of stay, and it determines a higher risk of being institutionalized.
... Therefore, the occurrence of pressure ulcers can be a strong predictor and indicator of mortality. There are many morbidities associated with pressure ulcer like pain, depression, local infection, osteomyelitis, anemia, sepsis, gas gangrene, necrotizing fasciitis (rare) and death [22,23]. About 50% of stage II, and 95% of stage III and IV pressure ulcers do not heal within eight weeks [24]. ...
Introduction: Pressure ulcer incidence rate continuously increase alarming-both community and hospital acquired. Nurses’ response may have an important role in pressure ulcer prevention. This study aims to assess the oncology nurses’ attitude, knowledge and perceived barriers towards pressure ulcer prevention and identify the type of pressure ulcer training they had attended.
Method: The respondents of this study are oncology nurses working in Comprehensive Cancer Center. A cross-sectional descriptive research survey and convenience sampling technique was used. This study involved 118 nurses from cancer center.
Result: A positive attitude (mean=51.18%) was reported by oncology nurses concerning pressure ulcer prevention with a high frequency of agreement to the positive statements. The condition of the patient was the leading perceived barrier to a proper assessment of pressure ulcer (76%) and followed by appropriate application of prevention measures (67%). Lack of time, lack of cooperation, lack of staff also was reported as hindrances. In service and lectures topped the educational training they had attended.
Conclusion: Oncology nurses have a positive attitude towards pressure ulcer prevention. Nurses' positive response may be utilized to achieve the overall goal of decreasing incidence and recurrence of pressure ulcer among cancer patients. Though some trends may be deemed inevitable, continuous education and innovative approach may be implemented to help in fulfilling the roles and responsibilities set for each nurse working in a clinical setting.
... It is known that serum albumin levels, which do indirectly reflect the nutritional status of a patient, may have an impact on wound healing in patients suffering from ulcers. Interestingly, previously published data showed no impact of serum albumin levels on the recurrence of ulcers (11,12). These findings were confirmed by our study. ...
... Whether a serum albumin level is more of a symptom than a reason for pressure ulcers needs to be further investigated. Scivoletto et al. (12) showed that all of the abnormally shifted blood labs including serum albumin levels, anemia and factors of inflammation normalized following defect closure by surgery. ...
Background:
Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting - notably in the case of recurrences - additional strain on the constantly reduced resources in public health care. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center.
Methods:
In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence. The hospital patient database search included all patients with a diagnosis of pressure ulcers of the torso and lower extremity.
Results:
One hundred sixty-three patients were diagnosed with pressure ulcers and 55 patients with 63 pressure ulcers met our inclusion criteria. The 17 recurrences (27%) had an average follow-up of 728 days. Most presented with lesions of the ischial tuberosity (n=24). Recurrence was statistically associated with defect size (p=0.013, Cox regression analysis), and serum albumin levels (p=0.045, Spearman correlation), but no association was found for body mass index, bacterial profile, comorbidities, localization, previous surgery, or time-to-admission for reconstruction (all p>0.05).
Conclusions:
Supported by the recent literature we identified factors like defect size to be associated with pressure ulcer recurrence, but not with time-to admission for reconstruction or number of previous debridements. Whether laboratory values like serum albumin levels were the cause, the result or associated with pressure ulcer recurrence warrants further investigation. This article is protected by copyright. All rights reserved.
... Therefore, the occurrence of pressure ulcers can be a strong predictor and indicator of mortality. There are many morbidities associated with pressure ulcer like pain, depression, local infection, osteomyelitis, anemia, sepsis, gas gangrene, necrotizing fasciitis (rare) and death [22,23]. About 50% of stage II, and 95% of stage III and IV pressure ulcers do not heal within eight weeks [24]. ...
... Moreover, nutritional deficits, bladder and bowel dysfunction resulting in skin moisture, hypoalbunemia and anaemia (1,4,38,39) have also been linked to PU after a SCI. These have not been considered in the present study and could possibly be different between patients who received the gel mattress and those who received the multi-layer foam dressing. ...
Individuals with spinal cord injury are at risk of sacral pressure ulcers due to, among other reasons, prolonged immobilisation. The effectiveness of a multi-layer foam dressing installed pre-operatively in reducing sacral pressure ulcer occurrence in spinal cord injured patients was compared to that of using a gel mattress, and stratified analyses were performed on patients with complete tetraplegia and paraplegia. Socio-demographic and clinical data were collected from 315 patients admitted in a level-I trauma centre following a spinal cord injury between April 2010 and March 2016. Upon arrival to the emergency room and until surgery, patients were transferred on a foam stretcher pad with a viscoelastic polymer gel mattress (before 1 October 2014) or received a multi-layer foam dressing applied to their sacral-coccygeal area (after 1 October 2014). The occurrence of sacral pressure ulcer during acute hospitalisation was similar irrespective of whether patients received the dressing or the gel mattress. It was found that 82% of patients with complete tetraplegia receiving the preventive dressing developed sacral ulcers as compared to only 36% of patients using the gel mattress. Although multi-layer dressings were suggested to improve skin protection and decrease pressure ulcer occurrence in critically ill patients, such preventive dressings are not superior to gel mattresses in spinal cord injured patients and should be used with precaution, especially in complete tetraplegia.
