Association of serum albumin level, feeding route, and mobility status with pressure ulcer presence in bedridden adults receiving long-term care

Pressure ulcers are a largely preventable complication and an important patient-safety concern in community and home-care settings. Evidence from primary care–led home-care cohorts remains limited, particularly regarding how routine functional and laboratory markers relate to pressure ulcer presence. We examined associations between mobility, nutritional indicators, feeding route, and inflammatory markers—including serum albumin and the C-reactive protein (CRP)–to–albumin ratio (CAR)—and pressure ulcer presence in adults receiving home-care services. This retrospective, cross-sectional study was conducted in a primary care–led home-care unit. Records of 983 patients screened between October 1, 2024 and January 14, 2025 were reviewed. Adults with limited mobility (semi-mobile or immobile) who had same-day albumin and CRP measurements and a documented Norton assessment were included. Pressure ulcer presence served as the primary variable of interest. CAR was calculated using same-day CRP and albumin values. Group comparisons, ROC analyses, and multivariable logistic regression were performed; calibration was assessed using the Hosmer–Lemeshow test. A complete-case approach was used. The analytic cohort included 328 patients (mean age 77.8 ± 15.0 years; 68.6% female). Pressure ulcer prevalence was 8.2% (27/328). Ulcer prevalence was higher in immobile than in semi-mobile patients (16.4% vs. 4.1%; p < 0.001) and differed by feeding route (p < 0.001). Patients with ulcers had lower albumin (35.8 ± 4.1 vs. 38.0 ± 4.5 g/L; p = 0.015) and lower Norton scores (12.3 ± 2.5 vs. 14.6 ± 2.6; p < 0.001). CAR was higher in the ulcer group (0.421 [IQR 0.61] vs. 0.157 [IQR 0.38]; p = 0.005) and showed modest discrimination (AUC 0.662; 95% CI 0.559–0.765). In multivariable analysis, oral feeding (vs. non-oral) was associated with lower odds of ulcers (OR 0.116; 95% CI 0.028–0.481; p = 0.003) and semi-mobility (vs. immobility) with lower odds (OR 0.291; 95% CI 0.121–0.700; p = 0.006); albumin showed a non-significant trend (p = 0.069). The combined model yielded an AUC of 0.760 (95% CI 0.663–0.857) with adequate calibration (Hosmer–Lemeshow p = 0.335). In primary care–led home-care patients with limited mobility, pressure ulcer presence was associated with functional dependency (mobility and feeding route) and higher inflammatory burden. CAR may provide complementary information alongside functional assessment, but findings are exploratory and require external validation. These findings may inform population-level prioritization of preventive care in community and home-care services, rather than individual clinical decision.