Deprez Julie, Ohde Nils, Eilegård Wallin Alexandra, Bååth Carina, Hommel Ami, Hultin Lisa, Josefson Anna, Kottner Jan, Beeckman Dimitri
Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Int Wound J. 2024 Jul;21(7):e14962. doi: 10.1111/iwj.14962.
Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.
失禁相关性皮炎（IAD）是一种因长期接触尿液或粪便而引起的刺激性接触性皮炎，会对患者的舒适度和生活质量产生重大影响。识别IAD发生的预后因素有助于加强管理、支持预防措施并指导未来研究。本系统评价的目的是总结IAD发生预后因素的实证证据。本研究纳入了描述与IAD相关预后因素的前瞻性和回顾性观察性研究或临床试验。对研究的设置、时间、语言、参与者或地理区域均无限制。排除标准包括综述、社论、评论、方法学文章、给编辑的信、横断面研究和病例对照研究以及病例报告。从创刊至2024年4月在MEDLINE、CINAHL、EMBASE和Cochrane图书馆进行检索。由两名独立 reviewers 使用QUIPS和CHARMS-PF进行数据提取来评估这些研究。由于研究的异质性，采用了叙述性综合方法，并使用“基于方向的投票计数”方法和符号检验。使用改编的GRADE标准评估证据的总体确定性。该综述纳入了12项研究，确定了15个潜在预测因素。中等质量的证据表明，排便频率增加、活动受限和摩擦/剪切问题是IAD发生的危险因素。低质量证据支持女性、老年、使用血管加压药和稀便/水样便是危险因素。排便频率增加、活动受限和摩擦/剪切问题似乎是IAD发生的危险因素。没有足够的证据支持女性、老年、稀便/水样便和使用血管加压药的预测有效性。各研究之间存在很大的方法学差异，难以进行比较。未来应在不同环境中开展纳入本综述结果的大规模队列研究。
