A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results.
BACKGROUND
Various scales have been devised to predict development of pressure ulcers on the basis of clinical and laboratory data, such as the Braden Scale (Braden score), which is used to monitor activity and skin conditions of bedridden patients. However, none of these scales facilitates clinically reliable prediction.


OBJECTIVE
To develop a clinical laboratory data-based predictive equation for the development of pressure ulcers.


METHODS
Subjects were 149 hospitalised patients with respiratory disorders who were monitored for the development of pressure ulcers over a 3-month period. The proportional hazards model (Cox regression) was used to analyse the results of 12 basic laboratory tests on the day of hospitalisation in comparison with Braden score.


RESULTS
Pressure ulcers developed in 38 patients within the study period. A Cox regression model consisting solely of Braden scale items showed that none of these items contributed to significantly predicting pressure ulcers. Rather, a combination of haemoglobin (Hb), C-reactive protein (CRP), albumin (Alb), age, and gender produced the best model for prediction. Using the set of explanatory variables, we created a new indicator based on a multiple logistic regression equation. The new indicator showed high sensitivity (0.73) and specificity (0.70), and its diagnostic power was higher than that of Alb, Hb, CRP, or the Braden score alone.


CONCLUSIONS
The new indicator may become a more useful clinical tool for predicting presser ulcers than Braden score. The new indicator warrants verification studies to facilitate its clinical implementation in the future.
Hatanaka
N
N
Department of Clinical Pathology, Tenri Hospital, Nara, Japan. hattan7@tenriyorozu-hp.or.jp
Yamamoto
Y
Y
Ichihara
K
K
Mastuo
S
S
Nakamura
Y
Y
Watanabe
M
M
Iwatani
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D004812:Epidemiologic Methods; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000097:blood / Q000209:etiology*; D011379:Prognosis; D012120:Respiration Disorders / Q000097:blood / Q000628:therapy; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index
D006454:Hemoglobins; D012709:Serum Albumin; D002097:C-Reactive Protein