Incidence and risk factors associated with pressure ulcers among patients with HIV infection.
OBJECTIVE
To assess the incidence of and risk factors for pressure ulcers among patients with advanced human immunodeficiency virus type 1 (HIV-1) infection.


METHODS
Multicenter trial that included 1258 consecutive patients infected with HIV-1 who had 1815 admissions to 16 acute care infectious disease units in Italy.


METHODS
Data were collected for demographic, clinical, immunologic, and virologic parameters. The chi-square test was used to compare categorical variables, and the Student t test was used for continuous variables. Univariate analysis was performed to examine possible risk factors for pressure ulcers by computing odds ratios; a multiple logistic regression model was used to obtain adjusted estimates of odds ratios while accounting for all possible risk factors.


RESULTS
The incidence of pressure ulcers was 2.31 per 100 admissions, 3.33 per 100 patients, and 1.06 per 1000 patient days. All stages of pressure ulcers were represented in the sample: 7 Stage I (15.9%), 24 Stage II (54.5%), 8 Stage III (18.2%), and 5 Stage IV (11.4%). Multivariate analyses showed that being female, length of hospitalization, and clinical markers of HIV infection were independently associated with pressure ulcers. Mortality rates were 50% among patients with pressure ulcers and 7.2% among patients without pressure ulcers (P <.0001), with an attributable mortality rate of 42.8% and an odds ratio of 12.96 (95% confidence interval 6.99-24.22).


CONCLUSIONS
A higher incidence of pressure ulcers was found in patients infected with HIV-1 when compared with noninfected patients. Because a longer hospitalization may increase the risk of developing a pressure ulcer, practitioners should be aware of the clinical conditions that may prolong a patient's hospital stay. Aggressive preventive strategies should be implemented to decrease the complications associated with pressure ulcers among patients infected with HIV-1.
Nicastri
Emanuele
E
National Institute for Infectious Diseases, L. Spallanzani, IRCCS, Rome, Italy.
Viale
Pierluigi
P
Lyder
Courtney H
CH
Cristini
Francesco
F
Martini
Lorena
L
Preziosi
Gianni
G
Dodi
Ferdinando
F
Irato
Laura
L
Pan
Angelo
A
Petrosillo
Nicola
N
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D012307:Risk Factors