key: cord-0930585-sdf6z6fx
authors: McLarney, Brett D.; Le Guen, Claire L.; Huang, Simo; Ramsey, Frederick; Soans, Rohit; Hsu, Sylvia
title: Predictors of COVID-19 Disease Severity Augment the Braden Scale in the Prediction of Pressure Ulcer Development among COVID-19-Positive Intensive Care Unit Patients: A Case-Control Study
date: 2022-02-25
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2022.01.021
sha: e84bf1e3b2772cde284efef37a8c791f38a32889
doc_id: 930585
cord_uid: sdf6z6fx

nan

Pressure ulcer (PU) development among COVID-19-positive intensive care unit (ICU) patients is emerging 2 as a unique, albeit incompletely understood, problem for healthcare systems. 1 Improvement in the risk 3 stratification of COVID-19-positive patients with respect to PU development could allow for better 4 patient outcomes with more efficient healthcare utilization. Immobility, reduced tissue perfusion, 5 hyperinflammation, and vasopressor requirement not only play pathogenic roles in PU development but 6 are also salient characteristics of critically ill COVID-19-positive patients. [1] [2] [3] As such, we hypothesized 7 that independent risk factors for PU development in COVID-19-positive ICU patients could be identified 8 from patient data or labs, obtained within their first 24 hours of hospital admission, that portend 9 increased COVID-19 disease severity.

Medical charts corresponding to 606 COVID-19-positive patients admitted to Temple University 11 Health System between 3/17/2020 and 5/4/2020 were analyzed. Patients who had no PU upon 12 admission and required ICU-level care for >24 hours at any point during their admission were included in 13 the study. A patient was determined to have a PU if the patient had wound care notes staging a wound 14 as a PU, or if the wound had a description matching that of a PU at stage ≥1, and the etiology was not 15 otherwise specified -authors reviewed each chart to make this determination. 3 A multivariable logistic 16 regression model was built to identify the independent risk factors for PU development using patient 17 data and labs collected within their first 24 hours of hospital admission. The number of hours each 18 patient spent in the ICU was included in the model to control for this potential confounder.

Of the 606 COVID-19-positive patients, 148 met inclusion criteria. Of the 148 patients, 37 20 developed a PU. Univariable analysis identified Braden Scale score and 'D-dimer >0.5 µg/mL and 21 fibrinogen <2.0 mg/mL' (a binary variable intended to capture patients presenting with a late-stage, consumptive coagulopathy) as being significantly associated with PU development (Table 1) 

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