Nutrition and Dietetics, School of Exercise and Nutrition Sciences, Faculty of Health, QUT, Brisbane, QLD, Australia.
The Prince Charles Hospital, Nutrition and Dietetics Department, Chermside, QLD, Australia.
Clin Nutr. 2018 Oct;37(5):1569-1574. doi: 10.1016/j.clnu.2017.08.014. Epub 2017 Aug 19.
Pressure injuries (PI) are a significant clinical problem across all healthcare facilities, associated with poor patient outcomes, increased length of stay and healthcare costs. Whilst it is known that underweight (Body Mass Index (BMI) < 18.5 kg/m) and malnourished individuals have an increased risk of developing PI, few studies have investigated the effects of obesity (BMI ≥ 30 kg/m) and morbid obesity (BMI ≥ 40 kg/m) on PI prevalence. This study aimed to determine whether PI prevalence was associated with levels of obesity; the complex association between morbid obesity, malnutrition and PI prevalence in hospital inpatients was also explored.
Data collected from annual Queensland Patient Safety Bedside Audits conducted between 2010 and 2015 was used to examine the outcomes of interest (n = 2479). Bivariate tests were used to explore relationships between age, gender, BMI, malnutrition and PI prevalence. Regression analysis explored associations between BMI, malnutrition and PI, adjusting for potential confounders.
Overall PI prevalence was 6.9% and was significantly higher in the underweight and morbidly obese groups (underweight 12.7%, healthy weight 7.8%, overweight 5.7%, obese 4.8%, morbidly obese 12%; p = 0.001). In addition to BMI, malnutrition and age were significantly associated with PI prevalence. After adjusting for confounders, morbidly obese inpatients had over three times the odds of developing a PI compared to healthy weight inpatients (OR = 3.478, 95% CI 1.657-7.303; p = 0.001). Morbidly obese inpatients who were also malnourished had eleven-fold greater odds of developing a PI compared to the morbidly obese well-nourished in logistic regression analysis (OR = 11.143, 95% CI 2.279-54.481, p = 0.003).
Morbid obesity is a significant and independent risk factor for PI development. However, the clustering of nutritional risk factors (morbid obesity and malnutrition) substantially increases this risk. Therefore, routine and formal assessment of both BMI and malnutrition status are important to enable the identification of patients at high risk of PI.
压力性损伤（PI）是所有医疗机构都面临的重大临床问题，与患者预后不良、住院时间延长和医疗保健成本增加有关。尽管已经知道体重过轻（身体质量指数（BMI）<18.5kg/m）和营养不良的人发生 PI 的风险增加，但很少有研究调查肥胖（BMI≥30kg/m）和病态肥胖（BMI≥40kg/m）对 PI 患病率的影响。本研究旨在确定 PI 患病率是否与肥胖水平有关；还探讨了病态肥胖、营养不良和住院患者 PI 患病率之间的复杂关系。
使用 2010 年至 2015 年期间进行的年度昆士兰患者安全床边审计收集的数据来检查研究结果（n=2479）。使用双变量检验来探讨年龄、性别、BMI、营养不良和 PI 患病率之间的关系。回归分析探讨了 BMI、营养不良和 PI 之间的关联，同时调整了潜在的混杂因素。
总体 PI 患病率为 6.9%，在体重过轻和病态肥胖组中明显更高（体重过轻 12.7%，健康体重 7.8%，超重 5.7%，肥胖 4.8%，病态肥胖 12%；p=0.001）。除 BMI 外，营养不良和年龄与 PI 患病率显著相关。在调整混杂因素后，与健康体重的住院患者相比，病态肥胖的住院患者发生 PI 的可能性高出三倍以上（OR=3.478，95%CI 1.657-7.303；p=0.001）。在逻辑回归分析中，患有病态肥胖且营养不良的住院患者发生 PI 的可能性是病态肥胖且营养良好的住院患者的 11 倍（OR=11.143，95%CI 2.279-54.481，p=0.003）。
病态肥胖是 PI 发展的一个重要且独立的危险因素。然而，营养风险因素（病态肥胖和营养不良）的聚集大大增加了这种风险。因此，常规和正式评估 BMI 和营养不良状况对于识别 PI 风险较高的患者非常重要。
