Martin-Loeches Ignacio, Rose Louise, Afonso Elsa, Benbenishty Julie, Blackwood Bronagh, Boulanger Carole, Calvino-Gunther Silvia, Chaboyer Wendy, Coyer Fiona, Llaurado-Serra Mireia, Lin Frances, Rubulotta Francesca, Williams Ged, Deschepper Mieke, Francois Guy, Labeau Sonia O, Blot Stijn I
Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland; Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain.
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Int J Nurs Stud. 2022 May;129:104222. doi: 10.1016/j.ijnurstu.2022.104222. Epub 2022 Mar 8.
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.
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.
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).
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).
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.
压力性损伤是重症监护病房（ICU）患者常见的并发症，尤其是那些患有慢性阻塞性肺疾病（COPD）等合并症的患者。然而，目前尚无关于重症COPD患者压力性损伤的流行病学数据。
评估重症COPD患者中ICU获得性压力性损伤的患病率，并调查COPD状态、ICU获得性压力性损伤的存在与死亡率之间的关联。
这是一项对DecubICUs前瞻性收集数据的二次分析，DecubICUs是一项针对成年ICU患者压力性损伤的跨国一日点患病率研究。我们生成了一个汇总COPD和ICU获得性压力性损伤风险的倾向评分。该倾向评分用作匹配标准（1:1比例），以评估可归因于COPD的ICU获得性压力性损伤的比例。然后，该倾向评分用于回归建模，评估COPD与ICU获得性压力性损伤风险的关联，并检查与死亡率相关的变量（Cox比例风险回归）。
在纳入DecubICUs的13254例患者中，1663例（12.5%）有记录的COPD。COPD患者中ICU获得性压力性损伤的患病率更高：22.1%（95%置信区间[CI]20.2至24.2），而无COPD患者为15.3%（95%CI 14.7至16.0）。COPD与发生ICU获得性压力性损伤独立相关（比值比1.40，95%CI 1.23至1.61）；可归因于COPD的比例为6.4%（95%CI 5.2至7.6）。与无压力性损伤的非COPD患者相比，无COPD但有压力性损伤的患者（风险比[HR]1.07，95%CI 0.97至1.17）或无压力性损伤的COPD患者（HR 1.13，95%CI 1.00至1.27）死亡率无差异。有压力性损伤的COPD患者死亡率更高（HR 1.35，95%CI 1.15至1.58）。
重症COPD患者发生压力性损伤的风险在统计学上显著更高。此外，发生压力性损伤的患者死亡风险更高。因此，压力性损伤可能是预后不良状态的一个指标，有助于临床医生识别高死亡风险患者。此外，对重症COPD患者实施预防压力性损伤的干预措施至关重要。进一步的研究应确定对重症COPD患者进行早期干预是否可以改变压力性损伤的发生并改善预后。
