A Retrospective Observational Analysis of Factors Determining the Formation of Pressure Ulcers in ICU Patients Treated for COVID-19

Anna Woźniak,1 Jarosław Janc,2 Patrycja Leśnik,3 Natalia Słabisz,4 Izabella Uchmanowicz1 1Department of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland; 2Department of Anaesthesiology and Intensive Therapy, Hospital of the Ministry of the Interior and Administration, Wroclaw, Poland; 3Department of Microbiology, Wroclaw Medical University, Wroclaw, Poland; 4Department of Laboratory Diagnostics, 4th Military Clinical Hospital, Wroclaw, PolandCorrespondence: Anna Woźniak, Department of Nursing and Midwifery, Wroclaw Medical University, Bartla 5 Street, Wroclaw, 51-618, Poland, Email [email protected]: Critically ill COVID-19 patients are at heightened risk for pressure ulcers (PUs), with the pandemic altering both the frequency and location of PU development and challenging hospital preparedness. The study aimed to investigate clinical and demographic factors associated with PUs in critically ill COVID-19 patients, compared outcomes between those who did and did not develop PUs, and assessed the impact of septic shock, prone positioning, and other interventions on PU formation, prolonged hospitalization, and mortality.Materials and Methods: A retrospective analysis was conducted on 160 adults with lab-confirmed COVID-19 treated in the intensive care unit (ICU) of the 4th Military Clinical Hospital in Wroclaw (Poland) between September 2020 and September 2022. The criterion for inclusion in the study was confirmed COVID-19 disease and need for invasive ventilation. Demographic data, incidence of septic shock, use of the Extracorporeal Membrane Oxygenation (ECMO), prone positioning, colonization, survival rates, SAPS (Simplified Acute Physiology Score) II scores, and vasopressor (argipressin) requirements were recorded. Univariate and multivariate logistic regression identified significant predictors of PUs development.Results: PUs occurred in 48.12% (n=77) of patients. Septic shock was more prevalent among those with PUs (30.12% vs 16.88%, p=0.049). PUs group had higher mean SAPS II scores (56.40) and greater argipressin use (0.50 units, p=0.015). Length of stay was significantly longer for patients with PUs (mean=14.08 days, p< 0.001). Multivariate analysis showed that higher SAPS II scores, argipressin use, and extended hospitalization were independent risk factors, while 28-day survival was protective against PUs formation.Conclusion: PUs development in critically ill COVID-19 patients is strongly linked to disease severity, vasopressor requirements, and prolonged hospitalization. Targeted preventive measures focusing on these risk factors could help mitigate PUs incidence and improve patient outcomes.Keywords: pressure ulcers, COVID-19, SAPS II, prone positioning, septic shock, argipressin