Clinical and laboratory profile of hospitalized patients affected by pressure injury

1. Universidade Federal de Sergipe − Programa de Pós-graduação em Ciências da Saúde – Aracaju (SE), Brazil. 2. Universidade Federal de Sergipe − Centro de Ciências Biológicas e da Saúde − Departamento de Medicina − Aracaju (SE), Brazil. 3. Instituto Federal de Educação, Ciência e Tecnologia de Sergipe – Coordenadoria de Saúde Escolar − São Cristóvão (SE), Brazil. *Correspondence author: marcelinha_gama@hotmail.com Received: May 07, 2020 | Accepted: Sep. 23, 2020 ABSTRACT Objective: To characterize the clinical and laboratory profile of hospitalized patients affected by pressure injury (PI). Method: Retrospective and descriptive study, which included data from electronic medical records of 95 patients affected by PI during hospitalization. Results: There was a predominance of females (52.6%), mean age 74.8 ± 14 years, mean hospital stay was 76.9 ± 88.8 days. Most were admitted to the intensive care unit, with an average of 17.86 ± 36.58 days. Regarding the clinical condition, 60% were using a mechanical ventilator when they developed PI, 37.9% needed hemodialysis, 30.4% were diagnosed with some degree of protein-energy malnutrition and 54.7% progressed to death. The most frequent comorbidities were hypertension (63.16%), diabetes (43.16%) and neuropathy (33.68%). As for the laboratory profile, hypoalbuminemia (97.3%), hyperglycemia (87.8%), anemia (84.4%) and hyperuremia (78.9%) were present in more than two thirds of the sample.Conclusion: This study allowed to know the profile of patients affected by PI during hospitalization, which can serve as a basis for developing scientifically based effective preventive actions.


INTRODUCTION
Pressure injury (PI) is defined as a region of the skin with tissue suffering due to intense and / or prolonged pressure on soft tissues, usually in areas of bony prominence, with the possibility of being associated with shear, or it may also be related to medical devices or other type of artifact 1 .
Tissue damage results from external pressure in the tissue, caused by the contact surface being higher than the capillary perfusion pressure for longer than is necessary to recover the generated ischemia 2 .
The degree of tissue impairment is considered for the staging of PIs, which can be classified into: stage 1 (intact skin with unbleached hyperemia); stage 2 (partial loss of skin, with exposure of the dermis, or blister with serous content); stage 3 (total loss of the skin, with exposure of the subcutaneous tissue, besides being able to present granulation, slough and necrosis); stage 4 (total loss of skin, with exposure of other structures); deep tissue (intact skin or not, with dark red, brown or purple color that does not whiten, or blister with bloody content); and not classifiable (loss of skin in its full thickness covered by slough or eschar) 1 .
Stage 3, 4 and non-classifiable PIs, when acquired after admission to health institutions, are considered "never events", that is, unequivocal, serious and generally preventable adverse events 3 .These pressure-induced injuries are a highly prevalent worldwide problem, representing the most serious condition of impaired skin integrity as they result in numerous negative outcomes, such as clinical complications, physical and psychosocial impacts that directly impact on the quality of life of individuals [4][5][6] .
A health care quality indicator is configured 7

RESULTS
The sample consisted of 95 patients, 50 of whom were women (52.6%), with a mean age of 74.8 ± 14 years, whose average hospital stay was 76.9 ± 88.8 days.

DISCUSSION
The results of this study consist in the characterization of the clinical and laboratory profile of patients who developed LP during hospitalization. As for age, the individuals' advanced age (> 70 years) was observed. It is known that aging causes structural and functional changes in the skin.
Some changes in the skin of the elderly that can compromise tissue tolerance to pressure are: reduced skin thickness, junction between dermis and epidermis damaged, limited cell division, decreased subcutaneous fat, slowed vascular response and altered innervation and sensitivity 13 .
In addition, the elderly population represents an age group with impaired functional status, reduced activity and mobility, as well as longer hospital stays 14 . The impaired functional status was evidenced in the sample, since the majority had at least one diagnosis of underlying disease.
Results of a study pointed to a high association between systemic diseases and the existence of PI 15 .
Death was the outcome of hospitalization in more than half of the patients with PI. Researchers evaluated the survival rate in hospitalized patients and found that the average survival time for the group of individuals with PI was considerably shorter than the group without PI (94 vs. 414 days) 15 . Although these injuries are not a cause of death during hospitalization, they do increase the risk of infectious processes and hospital malnutrition 9 .
The average score on the Braden scale revealed "high These conditions accentuate bone prominences and / or provide a greater risk of skin rupture, being easily found in immobilized and elderly people 5 .
The most notified stage was "deep tissue", followed by "stage 2", diverging from other studies that point out "stage 2" as the most frequent 9 Regarding topography, the most affected body region was the gluteal region, followed by the sacrococcygeal region, diverging from other studies that report the sacral region as the most affected 9,23 . Despite this contrast, these body surfaces are close, in addition to being support regions when the individual assumes the supine position. In addition, these sites are often affected by dermatitis associated with fecal or urinary incontinence (DAI), which is considered a predisposing factor for PI 24 .