title: Prospective study of pressure ulcer risk in spinal cord injury patients.
abstract: Sixty men with spinal cord injury who had developed pressure ulcers in the past but whose skin was intact when they joined the study were followed for 2 years, or until a pressure ulcer developed. Forty of the men were contacted every 4-6 weeks to answer questions about their skin care practices and to provide a 24 hour urine sample. The others were only contacted at the beginning and the end of the study to answer a questionnaire and to provide a urine sample. Changes in skin collagen metabolism were monitored by measuring urinary excretion of a metabolite, glucosyl-galactosyl hydroxylysine (glu-gal Hyl), corrected for creatinine excretion. Sustained increases in levels of glu-gal Hyl excretion were detected at least 2 months and as much as 5 months in advance of overt clinical signs of ulcer development. Increased excretion of glu-gal Hyl was significantly associated (p < 0.05) with the development of a pressure ulcer. An increase in the urinary excretion of glu-gal Hyl is an indication of increased degradation of skin collagen. Body mass index (weight/height2) of 33% of subjects with pressure ulcers, and 12% of those without, was at least one standard deviation below the mean of all subjects. Thirty-six percent of those who smoked developed ulcers, while only 26% of the nonsmokers did.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Physical Medicine and Rehabilitation Department, Baylor College of Medicine, Houston, Texas 77030.
authors.forename: G P
authors.initials: GP
authors.lastname: Rodriguez
authors.forename: S L
authors.initials: SL
authors.lastname: Garber
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism; D006801:Humans; D006901:Hydroxylysine / Q000031:analogs & derivatives / Q000652:urine; D008297:Male; D008960:Models, Psychological; D010349:Patient Compliance; D003668:Pressure Ulcer / Q000209:etiology* / Q000517:prevention & control / Q000652:urine; D011446:Prospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000652:urine
chemical_list: D006901:Hydroxylysine; C001295:glucosylgalactosylhydroxylysine; D003094:Collagen