危重症患者的急性皮肤衰竭。
Acute Skin Failure in the Critical Care Patient.
机构信息
Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health; Jill Cox, PhD, RN, APN-C, CWOCN, is Clinical Associate Professor, Rutgers University; At NYU Langone Health in New York, New York, Daniel J. Smith, MA, is Data Analyst and Research Coordinator, Center for Innovations in the Advancement of Care; and Andy S. Chu, MS, RD, CDN, CNSC, FAND, is a registered dietitian, Food and Nutrition Services. Linda Rolnitzky, MS, is a biostatistician, New York, New York. Acknowledgments: This study was funded in whole by a grant from the American Nurses Credentialing Center Clinical Research Grants, American Nurses Foundation. The authors have disclosed no other financial relationships related to this article. Submitted April 11, 2019; accepted May 14, 2019; published ahead of print November 27, 2019.
出版信息
Adv Skin Wound Care. 2020 Apr;33(4):192-201. doi: 10.1097/01.ASW.0000604172.69953.23.
OBJECTIVE
The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population.
METHODS
Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model.
RESULTS
Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively.
CONCLUSIONS
The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.
目的
本研究旨在在前人关于重症患者急性皮肤衰竭（ASF）预测因素的研究基础上进一步探讨。
方法
研究人员进行了一项回顾性病例对照研究，包括主分析和验证分析。数据从纽约州规划与研究合作系统中提取。主分析纳入 415 例医院获得性压疮（HAPI）患者和 194872 例无 HAPI 对照者。然后，研究人员随机抽取 100 例 HAPI 患者和 300 例无 HAPI 对照者进行验证分析。采用逐步逻辑回归模型。研究人员为主分析和验证分析生成了受试者工作特征曲线，评估回归模型的整体效用。
结果
11 个变量与 ASF 显著相关：肾衰竭（比值比[OR]，1.4，P =.003）、呼吸衰竭（OR，2.2；P = <.001）、动脉疾病（OR，2.4；P =.001）、营养受损（OR，2.3；P = <.001）、脓毒症（OR，2.2；P = <.001）、感染性休克（OR，2.3；P = <.001）、机械通气（OR，2.5；P = <.001）、血管手术（OR，2.2；P =.02）、骨科手术（OR，3.4；P = <.001）、周围坏死（OR，2.5；P =.003）和普通外科手术（OR，3.8；P = <.001）。主分析和验证分析的曲线下面积分别为 0.864 和 0.861。
结论
最终模型支持前人的研究结果，与目前重症患者 ASF 的定义一致。
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