Pressure Ulcer Risk in ICU Patients With COVID-19

One nurse looking at the medical ventilator screen. ICU COVID ward
Independent risk factors for pressure ulcers in ICU patients admitted with COVID-19 are identified from patient data.

Risk factors for pressure ulcer development in patients with COVID-19 admitted to the intensive care unit (ICU) were outlined in study data published in the Journal of the American Academy of Dermatology.

Pressure ulcer development among COVID-19-positive ICU admittees is an emerging health care concern, the study authors stated. To identify predictive factors of pressure ulcer development in patients with severe COVID-19, investigators reviewed the medical records of patients admitted to Temple University Health System from March 17, 2020 to May 4, 2020. Eligible patients had no pressure ulcer on admission and required ICU-level care for at least 24 hours. Pressure ulcers were identified per wound care notes in the medical record. Multivariable logistic regression models were used to identify independent risk factors for pressure ulcers based on data and laboratory tests  collected within the first 24 hours of hospital admission.

The cohort study included 148 patients, of whom 37 developed a pressure ulcer. Median Braden Scale score was 16 (interquartile range [IQR], 14-20), indicating moderate to mild baseline risk for pressure ulcer development. In adjusted regression models, Braden Scale score was substantially associated with risk for pressure ulcer development (P =.0486). Additional predictive factors included high body mass index (P =.0353) and increasing hours spent in the ICU (P <.0001). Notably, patients with D- dimer greater than 0.5 μg/mL and fibrinogen less than 2.0 mg/mL upon admission were 12 times more likely to develop pressure ulcers than other patients (odds ratio [OR], 12.1; 95% CI, 1.86-78.6; P =.0091).

Results from this study suggest to the investigators that predictors of COVID-19 disease severity—including consumptive D-dimer levels, fibrinogen levels, and body mass index—may also be used to assess pressure ulcer risk. “Severe COVID-19 disease may participate directly in PU pathogenesis via microvascular thrombosis or simply predispose patients to other risk factors such as vasopressor requirement,” investigators wrote. “The precise mechanism by which these biomarkers associate with PU development remains the subject of future investigation.”


McLarney BD, Le Guen CL, Huang S, Ramsey F, Soans R, Hsu S. Predictors of COVID-19 disease severity augment the Braden scale in the prediction of pressure ulcer development among COVID-19-positive intensive care unit patients: a case-control study. J Am Acad Dermatol. Published online February 24, 2022. doi: 10.1016/j.jaad.2022.01.021