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

TY - JOUR

T1 - Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease

T2 - A propensity score adjusted analysis

AU - DecubICUs Study Teamthe European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators (electronic supplement 1)

AU - Martin-Loeches, Ignacio

AU - Rose, Louise

AU - Afonso, Elsa

AU - Benbenishty, Julie

AU - Blackwood, Bronagh

AU - Boulanger, Carole

AU - Calvino-Gunther, Silvia

AU - Chaboyer, Wendy

AU - Coyer, Fiona

AU - Llaurado-Serra, Mireia

AU - Lin, Frances

AU - Rubulotta, Francesca

AU - Williams, Ged

AU - Deschepper, Mieke

AU - Francois, Guy

AU - Labeau, Sonia O.

AU - Blot, Stijn I.

N1 - Funding Information: This project received funding from the European Society of Intensive Care Medicine (ESICM), the Flemish Society for Critical Care Nurses (VVIZV), and the HOGENT Fund for Applied Research. SIB holds a research mandate from the Special Research Fund at Ghent University. In the UK, infrastructure support was provided by the National Institute for Health Research (NIHR) Imperial Biomedical Funding Information: Research centre (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. LR was funded by a TD Nursing Professorship in Critical Care Research from Sunnybrook Research Institute, Toronto, Canada. The ESICM financed and co-administered the online data collection platform, provided a study webpage, and supported study administration. The other funding sources had no role in this work. Publisher Copyright: © 2022 Elsevier Ltd

PY - 2022/5

Y1 - 2022/5

N2 - 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.

AB - 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.

KW - Comorbidity

KW - COPD

KW - Decubitus ulcers

KW - Intensive care

KW - Pressure injuries

UR - http://www.scopus.com/inward/record.url?scp=85126910144&partnerID=8YFLogxK

U2 - 10.1016/j.ijnurstu.2022.104222

DO - 10.1016/j.ijnurstu.2022.104222

M3 - Article

AN - SCOPUS:85126910144

SN - 0020-7489

VL - 129

JO - International Journal of Nursing Studies

JF - International Journal of Nursing Studies

M1 - 104222

ER -