Catalá Espinosa A I, Hidalgo Encinas Y, Cherednichenko T, Flores Lucas I, González Tamayo R, García-Martínez M Á, Herrero-Gutiérrez E
Servicio de Medicina Intensiva, Hospital de Torrevieja, Alicante, España.
Servicio de Medicina Intensiva, Hospital de Torrevieja, Alicante, España.
Enferm Intensiva. 2014 Jul-Sep;25(3):107-13. doi: 10.1016/j.enfi.2014.03.002. Epub 2014 May 10.
This study aims to evaluate the association between body mass index (BMI), incidence and severity of pressure ulcers (PU) in patients admitted to the Intensive Care Unit (ICU), and describe the differential prognosis of patients with PU and factors that modify it.
Case-control study with observation period of 15 months. We collected baseline variables, prognostic scales, therapies and clinical outcome. Univariate analysis was performed for each outcome variable between cases and controls using the appropriate hypothesis test depending on the nature of the variables. ROC curve for BMI and PU. Logistic regression with PU as dependent variable and the covariates that reached p<0.05 in the bivariate analysis. Correlation using Pearson or Spearman was made between BMI, albumin, days to diagnosis of UPP, immobilization, and PU degree. Significance level at p <0.05.
77 patients developed PU and 231 controls were chosen. The cases had higher APACHE II (p=0.043) and SAPS 3 (p=0.023), length of stay in ICU and mechanical ventilation (p<0.001). BMI≥40 was associated with UPP (p=0.024 OR=3.23 CI95% 1.17-8.93). There was a significant association between PU degree, length of stay and MV (p<0,001), but not with immobilization, dynamic support surface and death rate. Multivariate analysis found association between PU, length of MV (p=0.013, OR 1.08, CI95% 1.01-1.16) and kidney replacement therapy (p=0.013, OR 3.55 CI95% 1.31-9.64), with BMI≥40 as a confounding factor.
Length of mechanical ventilation and renal replacement therapy are risk factors for pressure ulcer development, and BMI≥40 acts as a confounding factor. PU development and its maximum degree are not associated with a worse prognosis.
本研究旨在评估重症监护病房（ICU）患者的体重指数（BMI）与压疮（PU）的发生率及严重程度之间的关联，并描述PU患者的不同预后情况以及影响预后的因素。
病例对照研究，观察期为15个月。我们收集了基线变量、预后量表、治疗方法及临床结局。根据变量的性质，对病例组和对照组的每个结局变量进行单因素分析，并采用适当的假设检验。绘制BMI与PU的ROC曲线。以PU为因变量，对双变量分析中p<0.05的协变量进行逻辑回归分析。对BMI、白蛋白、PU诊断天数、制动情况及PU程度进行Pearson或Spearman相关性分析。显著性水平为p<0.05。
77例患者发生了PU，并选取了231例对照。病例组的急性生理与慢性健康状况评分系统II（APACHE II）（p=0.043）和序贯器官衰竭评估（SAPS 3）（p=0.023）、ICU住院时间及机械通气时间更高（p<0.001）。BMI≥40与PU相关（p=0.024，比值比[OR]=3.23，95%置信区间[CI] 1.17 - 8.93）。PU程度、住院时间和机械通气之间存在显著关联（p<0.001），但与制动、动态支撑面及死亡率无关。多因素分析发现PU与机械通气时间（p=0.013，OR 1.08, 95% CI 1.01 - 1.16）和肾脏替代治疗（p=0.013，OR 3.55，95% CI 1.31 - 9.64）之间存在关联，BMI≥40为混杂因素。
机械通气时间和肾脏替代治疗是压疮发生的危险因素，BMI≥40为混杂因素。PU的发生及其最大程度与预后较差无关。
