Correlations between admission nutritional markers and pressure injury in elderly patients with chronic obstructive pulmonary disease_West China Medical Journal

Authors：

YANG Tao ^1,2 ,  HU Wen ^1,3 , CHENG Yi ³ , GONG Jie ³

1. West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Geriatrics, Dujiangyan People’s Hospital, Dujiangyan, Sichuan 611830, P. R. China;
3. Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HU Wen, Email: wendy_nutrition@163.com

Keywords：

Pressure injury; chronic obstructive pulmonary disease; elderly patient; nutritional markers; early warning

DOI：

10.7507/1002-0179.202207171

Video：

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Objective To explore the correlations between nutritional markers and pressure injury (PI) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods Retrospective analysis was conducted on elderly patients with COPD and PI who were admitted to the geriatric department of West China Hospital of Sichuan University or Dujiangyan People’s Hospital between January 2020 and December 2021. The blood biochemical indicators mainly including nutritional markers were collected, and their correlations with PI risk factor index Braden score and PI severity index PI stage were analyzed. Results A total of 293 patients with COPD and PI were included. Among the five Braden score groups, the differences in the levels of albumin and prealbumin were statistically significant (P<0.05), and the Braden score was positively correlated with albumin (r_s=0.241, P<0.001), prealbumin (r_s=0.179, P=0.002), and hemoglobin (r_s=0.199, P=0.001). Among the six PI stage groups, the differences in the levels of albumin, globulin, red blood cell count, serum sodium, blood chloride and C-reactive protein were statistically significant (P<0.05), and the PI stage was negatively correlated with albumin (r_s=−0.192, P=0.001), and positively correlated with serum sodium (r_s=0.139, P<0.001), blood chloride (r_s=0.184, P<0.001), and C-reactive protein (r_s=0.177, P=0.020). Conclusion When PI risk assessment and severity assessment are performed on elderly COPD patients, it is necessary to pay more attention to nutritional markers and assess whether the patients are at risk of protein malnutrition, which will help to improve the accuracy of PI risk assessment and severity prediction, and effectively improve the efficacy of PI prevention and treatment.

Citation： YANG Tao, HU Wen, CHENG Yi, GONG Jie. Correlations between admission nutritional markers and pressure injury in elderly patients with chronic obstructive pulmonary disease. West China Medical Journal, 2023, 38(1): 28-33. doi: 10.7507/1002-0179.202207171 Copy

1.	Donini LM, De Felice MR, Tagliaccica A, et al. Nutritional status and evolution of pressure sores in geriatric patients. J Nutr Health Aging, 2005, 9(6): 446-454.
2.	Bonnefoy M, Coulon L, Bienvenu J, et al. Implication of cytokines in the aggravation of malnutrition and hypercatabolism in elderly patients with severe pressure sores. Age Ageing, 1995, 24(1): 37-42.
3.	Casimiro C, García-de-Lorenzo A, Usán L. Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population. Nutrition, 2002, 18(5): 408-414.
4.	Zhang Z, Pereira SL, Luo M, et al. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients, 2017, 9(8): 829.
5.	朱胜春. 压疮高危患者临床特征及危险因素分析. 护理学报, 2010, 17(5): 72-74.
6.	刘又宁. 实用临床呼吸病学. 北京: 科学技术文献出版社, 2007: 313.
7.	Cox J, Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients. Crit Care Nurse, 2014, 34(6): 15-27.
8.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版)(一). 全科医学临床与教育, 2013(5): 484-491.
9.	European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The international guideline, 3rd edition. EPUAP/NPIAP/PPPIA, 2019. http://www.internationalguideline.com.
10.	Barczak CA, Barnett RI, Childs EJ, et al. Fourth national pressure ulcer prevalence survey. Adv Wound Care, 1997, 10(4): 18-26.
11.	Cabrerizo S, Cuadras D, Gomez-Busto F, et al. Serum albumin and health in older people: review and meta analysis. Maturitas, 2015, 81(1): 17-27.
12.	王春生, 时志斌, 刘安庆, 等. 脊髓损伤截瘫患者血白蛋白变化与压疮的关系. 中国临床康复, 2004, 8(8): 1422-1423.
13.	Hickson M. Malnutrition and ageing. Postgrad Med J, 2006, 82(963): 2-8.
14.	玛丽·宽德, 托尼亚·莱因哈德. 临床营养指导手册. 2 版. 周芸, 樊辉, 译. 北京: 人民卫生出版社, 2019: 21.
15.	Aguayo-Becerra OA, Torres-Garibay C, Macías-Amezcua MD, et al. Serum albumin level as a risk factor for mortality in burn patients. Clinics (Sao Paulo), 2013, 68(7): 940-945.
16.	Lin MY, Liu WY, Tolan AM, et al. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer. Am Surg, 2011, 77(10): 1286-1289.
17.	郑碧霞, 彭雅君, 任宇俊. 院外带入压疮相关因素分析及预防. 齐齐哈尔医学院学报, 2008, 29(12): 1427-1429.
18.	中国老年医学学会营养与食品安全分会, 中国循证医学中心, 《中国循证医学杂志》编辑委员会, 等. 老年患者家庭营养管理中国专家共识(2017 版). 中国循证医学杂志, 2017, 17(11): 1251-1259.
19.	马方清, 李湘波. Ⅱ、Ⅲ度营养不良合并电解质紊乱 42 例的诊疗体会. 中国医师杂志, 2003(6): 787.
20.	张静, 王衍富. 慢性阻塞性肺疾病患者能量代谢与营养不良研究进展. 医学与哲学, 2016, 37(2): 58-61.
21.	Litchford MD. Putting the 2019 nutrition recommendations for pressure injury prevention and treatment into practice. Adv Skin Wound Care, 2020, 33(9): 462-468.
22.	Bourdel-Marchasson I, Barateau M, Rondeau V, et al. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d’Evaluation. Nutrition, 2000, 16(1): 1-5.
23.	Roberts S, Chaboyer W, Leveritt M, et al. Nutritional intakes of patients at risk of pressure ulcers in the clinical setting. Nutrition, 2014, 30(7/8): 841-846.
24.	Amano K, Morita T, Baba M, et al. Effect of nutritional support on terminally ill patients with cancer in a palliative care unit. Am J Hosp Palliat Care, 2013, 30(7): 730-733.
25.	Banks MD, Graves N, Bauer JD, et al. Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals. Eur J Clin Nutr, 2013, 67(1): 42-46.
26.	Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later. Appl Health Econ Health Policy, 2015, 13(2): 167-179.
27.	Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness analysis of nutritional support for the prevention of pressure ulcers in high-risk hospitalized patients. Adv Skin Wound Care, 2016, 29(6): 261-267.

1. Donini LM, De Felice MR, Tagliaccica A, et al. Nutritional status and evolution of pressure sores in geriatric patients. J Nutr Health Aging, 2005, 9(6): 446-454.
2. Bonnefoy M, Coulon L, Bienvenu J, et al. Implication of cytokines in the aggravation of malnutrition and hypercatabolism in elderly patients with severe pressure sores. Age Ageing, 1995, 24(1): 37-42.
3. Casimiro C, García-de-Lorenzo A, Usán L. Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population. Nutrition, 2002, 18(5): 408-414.
4. Zhang Z, Pereira SL, Luo M, et al. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: a systematic review and meta-analysis. Nutrients, 2017, 9(8): 829.
5. 朱胜春. 压疮高危患者临床特征及危险因素分析. 护理学报, 2010, 17(5): 72-74.
6. 刘又宁. 实用临床呼吸病学. 北京: 科学技术文献出版社, 2007: 313.
7. Cox J, Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients. Crit Care Nurse, 2014, 34(6): 15-27.
8. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版)(一). 全科医学临床与教育, 2013(5): 484-491.
9. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The international guideline, 3rd edition. EPUAP/NPIAP/PPPIA, 2019. http://www.internationalguideline.com.
10. Barczak CA, Barnett RI, Childs EJ, et al. Fourth national pressure ulcer prevalence survey. Adv Wound Care, 1997, 10(4): 18-26.
11. Cabrerizo S, Cuadras D, Gomez-Busto F, et al. Serum albumin and health in older people: review and meta analysis. Maturitas, 2015, 81(1): 17-27.
12. 王春生, 时志斌, 刘安庆, 等. 脊髓损伤截瘫患者血白蛋白变化与压疮的关系. 中国临床康复, 2004, 8(8): 1422-1423.
13. Hickson M. Malnutrition and ageing. Postgrad Med J, 2006, 82(963): 2-8.
14. 玛丽·宽德, 托尼亚·莱因哈德. 临床营养指导手册. 2 版. 周芸, 樊辉, 译. 北京: 人民卫生出版社, 2019: 21.
15. Aguayo-Becerra OA, Torres-Garibay C, Macías-Amezcua MD, et al. Serum albumin level as a risk factor for mortality in burn patients. Clinics (Sao Paulo), 2013, 68(7): 940-945.
16. Lin MY, Liu WY, Tolan AM, et al. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer. Am Surg, 2011, 77(10): 1286-1289.
17. 郑碧霞, 彭雅君, 任宇俊. 院外带入压疮相关因素分析及预防. 齐齐哈尔医学院学报, 2008, 29(12): 1427-1429.
18. 中国老年医学学会营养与食品安全分会, 中国循证医学中心, 《中国循证医学杂志》编辑委员会, 等. 老年患者家庭营养管理中国专家共识(2017 版). 中国循证医学杂志, 2017, 17(11): 1251-1259.
19. 马方清, 李湘波. Ⅱ、Ⅲ度营养不良合并电解质紊乱 42 例的诊疗体会. 中国医师杂志, 2003(6): 787.
20. 张静, 王衍富. 慢性阻塞性肺疾病患者能量代谢与营养不良研究进展. 医学与哲学, 2016, 37(2): 58-61.
21. Litchford MD. Putting the 2019 nutrition recommendations for pressure injury prevention and treatment into practice. Adv Skin Wound Care, 2020, 33(9): 462-468.
22. Bourdel-Marchasson I, Barateau M, Rondeau V, et al. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d’Evaluation. Nutrition, 2000, 16(1): 1-5.
23. Roberts S, Chaboyer W, Leveritt M, et al. Nutritional intakes of patients at risk of pressure ulcers in the clinical setting. Nutrition, 2014, 30(7/8): 841-846.
24. Amano K, Morita T, Baba M, et al. Effect of nutritional support on terminally ill patients with cancer in a palliative care unit. Am J Hosp Palliat Care, 2013, 30(7): 730-733.
25. Banks MD, Graves N, Bauer JD, et al. Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals. Eur J Clin Nutr, 2013, 67(1): 42-46.
26. Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later. Appl Health Econ Health Policy, 2015, 13(2): 167-179.
27. Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness analysis of nutritional support for the prevention of pressure ulcers in high-risk hospitalized patients. Adv Skin Wound Care, 2016, 29(6): 261-267.

West China Medical Journal

Correlations between admission nutritional markers and pressure injury in elderly patients with chronic obstructive pulmonary disease

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